Anaphylaxis during General Anesthesia

Abstract

  Anaphylaxis occurring during anesthesia is one of the most severe adverse reactions. Anaphylaxis is a clinical syndrome that affects multiple organ systems. The clinical manifestations of anaphylaxis are derived from the acute release of mediators from mast cells and basophils. Effective anticipation, prevention, and treatment of these reactions is largely based on the knowledge and vigilance of the attending clinicians. In clinical medicine, prompt recognition with appropriate and aggressive therapy can help to avoid a disastrous outcome. Muscle relaxants are the agents most commonly responsible for intraoperative anaphylaxis. Other agents that are responsible include latex, hyponotics, antibiotics, plasma substitutes, and opioids. The initial steps in the management of anaphylaxis are the same as for all life-threatening events that control airway, breathing and circulation. Also, it should be stressed that increased vascular permeability, vasodilatation and decreased vascular resistance may lead to the need for large volumes of fluid replacement. Epinephrine, oxygen, and fluids are accepted first line treatments. A careful medical history that focuses on previous adverse reactions is most important. Previous anesthetic-associated reactions should be evaluated thoroughly, with specific testing if indicated. Beta-tryptase should be measured for assessment of the pathophysiology of the adverse reaction.