Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

Abstract

Background: Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important. Methods: A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted. Results: A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

“…40 One study demonstrated that significant delays in treatment with epinephrine occurred in about one-third of cases in Denmark. 41 Per case mortality was estimated to be one in 26.6 cases in the UK for all causative drugs, 40 an outcome very similar to that observed in France for mortality related to NMBA anaphylaxis, 39 and that reported for all causative drugs in the US 42 and Japan. 27 A perioperative anaphylaxis mortality rate of 0e1.4% was recently reported for Western Australia (2000e2009).…”

“…This approach is required to avoid under-or overdosing epinephrine and fluid resuscitation. 40,41,63 We recommend that timely administration of epinephrine is required for Grade IIeIV reactions. However, we can only suggest initial doses for Grades II (20 mg) and III (50 mg) reactions.…”

A case series of life-threatening succinylcholine-induced anaphylaxis

“…These results are in accordance with a previous report. 7 These results demonstrated that the rescue therapy was suboptimal and/or delayed in at least 70% of the reported patients. In only 55% of cases was the administered epinephrine dose in accordance with the French recommendations (i.e.…”

The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status

“…In one study, 45% of patients presented with grade III reactions (anaphylactic shock with circulatory instability) or grade IV reactions (cardiac arrest). 35 As life-threatening allergic reactions are seen as a relative contraindication to DPT by many allergists, this also presents an important barrier against performing DPT in perioperative allergy investigation.…”