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Perioperative anaphylaxis: Clinical manifestations, etiology, and management

Authors
Jerrold H Levy, MD, FAHA, FCCM
Dennis K Ledford, MD
Section Editor
John M Kelso, MD
Deputy Editors
Anna M Feldweg, MD
Nancy A Nussmeier, MD, FAHA

INTRODUCTION

Patients undergoing general anesthesia and surgery can experience complex physiologic changes. Recognition of an allergic reaction that occurs during anesthesia is potentially complicated by hypotension produced by intravenous or inhalational anesthetic agents, sympathectomy associated with spinal/epidural anesthesia, the inability of the anesthetized patient to communicate early symptoms such as itching, and coverage of the patient by surgical drapes that may obscure detection of cutaneous signs.

The prevalence, etiology, risk factors, clinical manifestations, and acute diagnosis of anaphylaxis during general anesthesia will be reviewed here. The evaluation of a patient who has experienced perioperative anaphylaxis, skin testing to the drugs that cause immunoglobulin E (IgE)-mediated reactions, and prevention of recurrent reactions, as well as the treatment of anaphylaxis from any cause, are discussed separately. (See "Perioperative anaphylaxis: Evaluation and prevention of recurrent reactions" and "Anaphylaxis: Emergency treatment".)

INCIDENCE

The incidence of anaphylaxis during general anesthesia is 1:10,000 to 1:20,000 [1-4]. The wide variability in estimates of prevalence and incidence reflects the difficulties in determining the denominator (or the total number of anesthesia cases), as well as limitations in diagnosing perianesthetic anaphylaxis. Perioperative anaphylaxis occurs equally in prepubertal girls and boys, but is more common in adult women than men [3].

MECHANISMS OF ANAPHYLAXIS

Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast cell- and basophil-derived mediators into the circulation [5,6]. (See "Pathophysiology of anaphylaxis".)

In this review (and increasingly in the literature), the term "anaphylaxis" applies to all of the following mechanisms of acute reactions (table 1) [7]:

                         

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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 06 00:00:00 GMT 2016.
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