Practical guidelines for the response to perioperative anaphylaxis

Perioperative anaphylaxis (POA) is a severe complication with a low incidence and diverse risk factors. Its low incidence makes a detailed survey of POA challenging. Recent large-scale surveys in Japan have focused on identifying the causative agents using the basophil activation test. Only facilities, such as university hospitals, that can dispatch samples for this test participate, which may introduce bias. We surveyed the incidence of POA primarily in secondary hospitals, such as the Saiseikai hospitals, throughout Japan. We targeted data collection for the year 2021. Thirty-five facilities answered (Supplementary 1, 2); we excluded 1 reporting no surgeries. In total, 70,523 surgeries were performed, with POA diagnosed in 7 cases. For diagnosis, the skin test was used in 3 cases and quantification of histamine and tryptase in 1 case. In 3 cases, diagnosis was based on the time to onset of POA after drug use. Multiple tests are important to ensure patient safety. However, in this survey, no hospital performed in vitro tests to identify the cause. This is major limitation, however, as many hospitals do not have experimental laboratories, we believe that this study, which focuses on secondary care institutions, contributes to the literature significantly by presenting the current situation in clinical practice.

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“…BAT requires active basophils within 4 hours of blood collection, limiting its use to facilities with flow cytometers. 8…”

Section: Discussionmentioning

confidence: 99%

“…BAT requires active basophils within 4 hours of blood collection, limiting its use to facilities with flow cytometers. 8 The mast cell activation test (MAT) uses cultured mast cells bound to serum IgE antibodies and, similar to BAT, detects cell surface marker changes. However, maintaining adequate activity in cultured mast cells requires further study.…”

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confidence: 99%

Incidence of perioperative anaphylaxis in 2021 in Japan: Survey of 34 hospitals of Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc

Suzuki

Liu

Yamashita

et al. 2022

Preprint

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“…To calculate the sample size, we estimated that the incidence rate of allergic reactions in patients without intraoperative propofol use was 0.1% in accordance with a previous report [ 1 ]. Assuming that the use of propofol is associated with a high risk of allergic reactions in patients with egg/soybean allergy, the incidence of allergic reactions caused by propofol in these patients was estimated to be 10%.…”

Section: Methodsmentioning

confidence: 99%

“…An allergic reaction to anesthetics, including anaphylaxis, is a serious perioperative complication. To avoid an allergic reaction, anesthesiologists refer to the patient’s allergic history when selecting the anesthetic agent [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Allergic reactions to propofol in adult patients with egg or soybean allergy: a retrospective cohort study from a large database of a single institute

2023

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Background In recent years, many reports have indicated that propofol is safe to administer to patients with egg/soybean allergy in Western countries. Egg allergy is more frequent in Asia, but there are limited reports regarding allergic reactions to propofol use among adults. This study aimed to determine whether propofol causes allergic reactions in patients with egg/soybean allergy. Methods Adult patients who underwent surgery involving anesthesiologists from 2018 to 2021 were included. In all patients, we reviewed food allergy information in their electronic medical record and extracted anesthetics. Patients with egg/soybean allergy were subdivided into two groups on the basis of intraoperative use of propofol. We evaluated each group for allergic reactions within 24 h after the induction of anesthesia. The primary outcome was a relative risk of allergic reactions after propofol use for patients with egg/soybean allergy. Results In total, 22,111 patients with 28,710 anesthesia records were identified. Among patients with egg/soybean allergy, 173 (0.8%) patients and 237 (0.8%) anesthesia records were included in the study. Among the records of egg-/soybean-allergic patients, 151 were administered propofol, and 86 were not. The relative risk of allergic reactions after propofol use for patients with egg/soybean allergy was 1.14 (95% confidence interval, 0.10–12.4; p = 0.74). Conclusion The use of propofol in patients with egg/soybean allergy does not significantly increase the relative risk of allergic reactions. Therefore, anesthesiologists can appropriately determine the indication for propofol, even in patients with egg/soybean allergy. Trial registration UMIN-CTN, UMIN000049321 registered 26 October 2022 — retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000056167

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“…In 2021, Japanese Society of Anesthesiologists developed a practical guide for anaphylaxis during anesthesia. [ 1 ] Drug-induced anaphylaxis can rapidly develop, with the speed depending on the severity of the anaphylaxis. [ 1 ] Therefore, the anesthesiologist should immediately begin treatment and subsequently make the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Anaphylaxis in the operating room treated with an anaphylaxis response kit: A case report

2023

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Anaphylaxis is a rapidly fatal complication of anesthesia, and it needs to be appropriately diagnosed and treated by anesthesiologists. A 37-year-old man underwent surgery for pneumothorax under general anesthesia. Postoperatively, the train-of four count was four, and sugammadex was administered. Soon after, the patient's oxygen saturation and blood pressure decreased, and skin flushing was noted. We suspected anaphylaxis and administered adrenaline. Once the blood pressure normalized, we administered hydrocortisone, famotidine, and d-chlorpheniramine maleate. Thereafter, his condition stabilized, he recovered well, and he was discharged. Blood samples obtained after the onset of the episode indicated anaphylaxis, and a prick test performed 10 weeks postoperatively confirmed sugammadex as the causative agent. We report a case of sugammadex-induced anaphylaxis, which we could properly diagnose and treat because an anaphylaxis kit was available in our department.

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Practical guidelines for the response to perioperative anaphylaxis

Cited by 22 publications

References 69 publications

Incidence of perioperative anaphylaxis in 2021 in Japan: Survey of 34 hospitals of Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc

Incidence of perioperative anaphylaxis in 2021 in Japan: Survey of 34 hospitals of Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc

Allergic reactions to propofol in adult patients with egg or soybean allergy: a retrospective cohort study from a large database of a single institute

Anaphylaxis in the operating room treated with an anaphylaxis response kit: A case report

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