Allergic reactions to anaesthesia

The incidence of life-threatening hypersensitivity reactions occurring during surgery and anaesthesia is around one in 10,000 procedures. Serious allergic reactions to anesthetic medications are rare and a usually attributable to factors other than the anesthetic. Neuromuscular blocking agents, natural rubber latex, and antibiotics are the most common causes of serious allergic reactions during surgery.^[1] The mortality rate from these reactions is about 3–6%.

Successful immediate treatment requires prompt recognition by the attending anaesthetist, or in the US, the attending anesthesiologist or nurse anesthetist. Adrenaline (epinephrine) remains the mainstay of treatment, with corticosteroids and antihistamines providing limited benefit in the acute situation.

Subsequent investigation aims to determine the responsible agent to allow its future avoidance. Skin testing is often useful to identify potentially cross-reactive compounds and appropriate therapeutic alternatives. This is done weeks after the initial reaction to allow the immune system to reset itself. However, skin testing can be misleading in giving false positive and false negative results.

References

↑ Hepner DL, Castells MC (2003). "Anaphylaxis during the perioperative period". Anesthesia and Analgesia 97 (5): 1381–95. doi:10.1213/01.ANE.0000082993.84883.7D. PMID 14570656.

Anesthesia (outline)

Types	General Spinal Epidural Conduction anesthesia Local Topical Intercostal nerve block Sedation / Twilight anesthesia Dental (Inferior alveolar nerve) Neuroleptanalgesic anesthesia

Techniques	Airway management Anesthesia provision in the US Arterial catheter Bronchoscopy Capnography Dogliotti's principle Drug-induced amnesia Intraoperative neurophysiological monitoring Nerve block Penthrox inhaler Tracheal intubation

Scientific Principles	Blood–gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect

Measurements	ASA physical status classification system Baricity Bispectral index Direct Fick method Entropy monitoring Fick principle Goldman index Guedel's classification Mallampati score Neuromuscular monitoring Thyromental distance

Instruments	Anaesthetic machine Anesthesia cart Boyle's machine Gas cylinder Laryngeal mask airway Laryngeal tube Medical monitor Odom's indicator Relative analgesia machine Vaporiser Double-lumen endotracheal tube Endobronchial blocker

Drugs	Benzodiazepine Etomidate General anaesthetic Inhalational anaesthetic Infiltration analgesia Ketamine Local anesthetic Methohexital Methoxyflurane Midazolam Neuraxial blockade Opiate Propofol Thiopental Thiopentone

Complications	Emergence delirium Allergic reactions Anesthesia awareness Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization

Fields of study	Cardiothoracic Geriatric Oral sedation dentistry

Professions	Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating Department Practitioners Certified Anesthesia Technician Certified Anesthesia Technologist Anaesthetic technician

History	A.C.E. mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation

Organizations	American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society

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