Abstract
The authors present a case of a patient with multiple episodes of perioperative anaphylaxis. The incidence and the most common causes of perioperative anaphylaxis are reviewed. The most common causes can vary by country and the type of perioperative medications used. The unique environment and the multiple medications and substances used in the anesthesia and surgical setting that make a definitive diagnosis challenging are outlined. A systematic strategy to recognize the reaction, identify the culprit, and direct future management are demonstrated. Management of the patient experiencing perioperative anaphylaxis requires close collaboration between the anesthesia, surgical, and allergy teams.
Keywords:
Anaphylaxis; Anesthesia; Hypersensitivity reactions; Intraoperative; Perioperative period.
Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
MeSH terms
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Aged
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Airway Management
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Analgesics, Opioid / adverse effects
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Anaphylaxis / chemically induced*
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Anaphylaxis / metabolism
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Anaphylaxis / therapy
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Anti-Bacterial Agents / adverse effects
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Anti-Infective Agents, Local / adverse effects*
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Antibiotic Prophylaxis
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Bacitracin / adverse effects
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Bronchodilator Agents / therapeutic use
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Chlorhexidine / adverse effects*
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Colloids / adverse effects
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Coloring Agents / adverse effects
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Drug Hypersensitivity / diagnosis*
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Drug Hypersensitivity / etiology
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Drug Hypersensitivity / metabolism
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Epinephrine / therapeutic use
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Fluid Therapy
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Glucocorticoids / therapeutic use
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Humans
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Hypnotics and Sedatives / adverse effects
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Immunoglobulin E / metabolism
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Intradermal Tests
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Latex Hypersensitivity / diagnosis
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Male
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Neuromuscular Blocking Agents / adverse effects
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Oxygen Inhalation Therapy
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Perioperative Period*
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Povidone-Iodine / adverse effects
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Recurrence
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Skin Tests
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Sugammadex / adverse effects
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Sympathomimetics / therapeutic use
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Transfusion Reaction
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Tryptases / metabolism
Substances
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Analgesics, Opioid
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Anti-Bacterial Agents
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Anti-Infective Agents, Local
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Bronchodilator Agents
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Colloids
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Coloring Agents
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Glucocorticoids
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Hypnotics and Sedatives
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Neuromuscular Blocking Agents
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Sympathomimetics
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Bacitracin
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Sugammadex
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Immunoglobulin E
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Povidone-Iodine
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Tryptases
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Chlorhexidine
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Epinephrine