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[Anesthetics responsible for anaphylactic shock. A French multicenter study]
M C Laxenaire1, D A Moneret-Vautrin, S Widmer
1Département d'Anesthésie-Réanimation, Hôpital Central, Nancy.
Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1990
Summary
Anaphylaxis during anesthesia is common, with muscle relaxants like suxamethonium being the primary culprits. Prompt diagnosis and avoidance of implicated drugs are crucial for patient safety.
Area of Science:
- Anesthesiology
- Allergology
- Immunology
Background:
- Perianaesthetic anaphylactoid shocks are a significant concern.
- Combined allergological and anesthetic consultations are emerging to investigate these events.
Purpose of the Study:
- To assess the incidence of anaphylaxis in France.
- To identify drugs involved in perianaesthetic anaphylaxis.
- To evaluate diagnostic methods for anaphylaxis.
Main Methods:
- A survey of 1,240 patients investigated in eight French Teaching Hospitals over four years.
- Diagnostic tests included skin tests, radioimmunological assay of specific IgE, leukocyte histamine release, and basophil degranulation tests.
- Investigations were conducted 6-8 weeks post-event.
Main Results:
- Anaphylaxis was diagnosed in 66.2% of investigated patients (821/1240).
- Muscle relaxants were responsible for 80% of anaphylaxis cases, with suxamethonium being the most frequent cause.
- General anesthetics accounted for 9.2%, opioids for 2.6%, and local anesthetics for a small fraction of cases. Latex and ethylene oxide involvement is increasing.
Conclusions:
- A thorough assessment with sensitive and specific tests is mandatory after any suspected anaphylactoid accident.
- Identifying the causative agent is critical to prevent future exposure and ensure patient safety.
- Anesthetists should exercise caution with muscle relaxants due to their high rate of involvement in anaphylaxis.