Suspected anaphylactic reactions associated with anaesthesia

Harper, N.J.N., Dixon, T., Dugué, P., Edgar, D.M., Fay, A., Gooi, H.C., Herriot, R., Hopkins, P., Hunter, J.M., Mirakian, R., Pumphrey, R.S.H., Seneviratne, S.L., Walls, A.F., Williams, P., Wildsmith, J.A., Wood, P., Nasser, A.S., Powell, R.K., Mirakhur, R. and Soar, J. , Association of Anaesthetists of Great Britain and Ireland (2009) Suspected anaphylactic reactions associated with anaesthesia. Anaesthesia, 64 (2), 199-211. (doi:10.1111/j.1365-2044.2008.05733.x).

Abstract

Summary (1) The AAGBI has published guidance on management of anaphylaxis during anaesthesia in 1990, 1995 and 2003. This 2008 update was necessary to disseminate new information. (2) Death or permanent disability from anaphylaxis in anaesthesia may be avoidable if the reaction is recognised early and managed optimally. (3) Recognition of anaphylaxis during anaesthesia is usually delayed because key features such as hypotension and bronchospasm more commonly have a different cause. (4) Initial management of anaphylaxis should follow the ABC approach. Adrenaline (epinephrine) is the most effective drug in anaphylaxis and should be given as early as possible. (5) If anaphylaxis is suspected during anaesthesia, it is the anaesthetist’s responsibility to ensure the patient is referred for investigation. (6) Serum mast cell tryptase levels may help the retrospective diagnosis of anaphylaxis: appropriate blood samples should be sent for analysis. (7) Specialist (allergist) knowledge is needed to interpret investigations for anaesthetic anaphylaxis, including sensitivity and specificity of each test used. Specialist (anaesthetist) knowledge is needed to recognise possible non-allergic causes for the ‘reaction’. Optimal investigation of suspected reactions is therefore more likely with the collaboration of both specialties. (8) Details of specialist centres for the investigation of suspected anaphylaxis during anaesthesia may be found on the AAGBI website http://www.aagbi.org. (9) Cases of anaphylaxis occurring during anaesthesia should be reported to the Medicines Control Agency and the AAGBI National Anaesthetic Anaphylaxis Database. Reports are more valuable if the diagnosis is recorded following specialist investigation of the reaction. (10) This guidance recommends that all Departments of Anaesthesia should identify a Consultant Anaesthetist who is Clinical Lead for anaesthetic anaphylaxis.

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Contributors

Author: A.F. Walls

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