Perioperative anaphylaxis: what should be known?

Area of Science:

• Anesthesiology
• Immunology
• Critical Care Medicine

Background:

• Perioperative anaphylaxis is a severe adverse event during anesthesia.
• It results from drug-induced hypersensitivity, primarily IgE-mediated.
• Neuromuscular blocking agents and antibiotics are common triggers.

Purpose of the Study:

• To review the pathophysiology, diagnosis, and management of perioperative anaphylaxis.
• To highlight the clinical presentation and severity grading.
• To discuss current therapeutic strategies and evidence gaps.

Main Methods:

• Literature review of perioperative anaphylaxis.
• Analysis of clinical patterns and diagnostic tools like the Ring and Messmer scale.
• Evaluation of management protocols including fluid resuscitation and epinephrine administration.

Main Results:

• Anaphylaxis presents with cardiovascular collapse (Grade III) or cardiac arrest (Grade IV).
• Diagnosis is presumptive, supported by tryptase levels and skin tests.
• Aggressive fluid therapy and epinephrine are crucial for management.

Conclusions:

• Perioperative anaphylaxis requires prompt recognition and management.
• Current evidence does not support preemptive preventive strategies.
• Further research is needed to optimize anaphylaxis prevention and treatment.