Abstract

BackgroundHypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. Identification of the risk factors may contribute to limit the incidence of these reactions. The aim of our study was to search for possible risk factors of severe perioperative hypersensitivity reactions in our study population.MethodsFor this study we retrospectively reviewed data from 193 patients who experienced drug hypersensitivity reactions during general anaesthesia. The diagnostic protocol consisted of 1) history of the reaction, 2) measurement of serum baseline tryptase and specific IgE-assays for latex, beta-lactams and succinylcholine, 3) skin tests for the agents listed in the anaesthesia chart and for others likely to be safe for future use, latex, and others medications administered during the perioperative period (i.e. antibiotics), 4) subdivision of our patients on the basis of two criteria: a) grade of severity of clinical reactions according to the Ring and Messmer classification; b) results of skin tests and/or serum specific IgE-assays.ResultsOne hundred of 193 patients had reactions of grade I, 32/193 patients had reactions of grade II, 55/193 patients had reactions of grade III and 6/193 patients had reactions of grade IV. A diagnosis of IgE-mediated reaction was established in 55 cases (28.50%); the most common causes were neuromuscular blocking agents, followed by latex and beta-lactams. Severe reactions were associated with older age (p = 0.025), asthma (p = 0.042), history of hypertension (p = 0.001), intake of serum angiotensin converting enzyme inhibitor medication (p = 0.012) or serum angiotensin II antagonist (p = 0.033), higher levels of basal tryptase (p = 0.0211). Cardiovascular symptoms (p = 0.006) and history of hypersensitivity to antibiotics (p = 0.029) were more frequently reported in IgE-mediated reactions.ConclusionsWe confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk.Electronic supplementary materialThe online version of this article (doi:10.1186/s12948-015-0017-9) contains supplementary material, which is available to authorized users.

Highlights

  • Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events

  • Patients A total of 193 patients (71 males and 122 females, mean age 37.5 ± 20.8 years) with peri-operative hypersensitivity reactions during general anaesthesia were included in this retrospective observational cohort study

  • The patients were further classified into two groups: group 0 consisting of 132/193 patients (68.40%) with grade I and II and group 1 consisting of 61/193 patients (31.60%) with grade III and IV reactions

Read more

Summary

Introduction

Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. It has been reported that all anaphylactic reactions induced from any trigger occurred more often and more severely in patients affected by non-controlled allergic rhinitis, eczema, and to a greater extent by asthma, COPD [9,12] and other respiratory diseases, cardiovascular diseases [13], systemic mastocytosis and/or other mast cell-related disorders [14,15,16] and on therapy with ACE-inhibitors [17]. The purpose of our study was to identify predisposing factors to perioperative anaphylaxis To this aim we associated several clinical and laboratory parameters with the grade of severity of documented hypersensitivity reactions occurring during surgical procedures in a population of patients referred to our center

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call