Epidemiology and Triggers of Severe Perioperative Anaphylaxis: An 8-Year Single-Center Study

Abstract

ObjectiveTo determine the features, rescue measures, outcomes, re-allergic reactions, and independent risk factors associated with severe anaphylaxis during surgery. DesignInstances of severe perioperative anaphylaxis were identified through perioperative electronic records, adverse event reporting records, and surveys of anesthesiologists. Confirmed cases were randomly matched 4:1 with control cases on the same operation day. Patient risk factors, surgery type, anesthetic technique, and perioperative medications, fluids, and blood transfusions were given in instances of severe perioperative anaphylaxis were compared with control cases. SettingA tertiary hospital in China. PatientsAll patients undergoing surgery and anesthesia in the operating room from January 2014 to February 2022. MeasurementsIncidence and the independent risk factors for severe perioperative anaphylaxis. Main results97 patients experienced severe perioperative allergic responses during the 266,033 surgeries performed, with the incidence rate of 3.6 per 10,000. 3 of 97 anaphylaxis patients experienced a severe allergic reaction again during the second surgery. The nested case-control study revealed that the independent triggers during surgery were allergy history (odds ratio 5.23; 95% confidence interval, 2.35-11.68; P<0.001), cisatracurium use (odds ratio 5.03; 95% confidence interval, 1.22-20.70; P<0.001), hydroxyethyl starch 130/0.4 use (odds ratio 5.36; 95% confidence interval, 2.99-9.60; P=0.025), and allogeneic plasma (odds ratio 11.02; 95% confidence interval, 3.78-35.95; P<0.001). ConclusionsPerioperative severe anaphylaxis is a rare but life-threatening complication. Previous allergic history, cisatracurium, hydroxyethyl starch 130/0.4, and allogeneic plasma may be the independent triggers. Early diagnosis of anaphylaxis and the timely administration of epinephrine are critical to allergic treatment. Avoiding exposure to allergens is effective for preventing severe allergic responses and the efficacy of glucocorticoids and antihistamines is controversial.