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Intraoperative medications associated with hemodynamically significant anaphylaxis.
Robert E Freundlich1, Neal M Duggal2, Michelle Housey2
1Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Ave S, Suite 526, Nashville, TN 37212.
Journal of Clinical Anesthesia
|November 23, 2016
Summary
Hemodynamically significant anaphylaxis during anesthesia is rare. Protamine and a personal history of anaphylaxis are key risk factors, not drug categories.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Clinical Immunology
- Pharmacovigilance
Background:
- Anaphylaxis during anesthesia poses significant risks.
- Identifying associated drugs and patient factors is crucial for prevention and management.
- Existing literature on risk factors is varied.
Purpose of the Study:
- To identify specific drugs and patient characteristics linked to hemodynamically significant anaphylaxis.
- To analyze the incidence and predictors of severe anaphylactic reactions during surgery.
Main Methods:
- Retrospective analysis of perioperative records from a tertiary care hospital.
- Screening algorithm to identify anaphylaxis cases, confirmed by clinical review.
- Matched case-control study comparing patients with and without anaphylaxis.
Main Results:
- Incidence of hemodynamically significant anaphylaxis was 1 in 8400 cases.
- Protamine was the only drug significantly associated with increased risk (OR, 11.78).
- A personal history of anaphylaxis was the strongest patient risk factor (OR, 77.1).
Conclusions:
- Hemodynamically significant anaphylaxis is a rare but serious anesthetic complication.
- Protamine and a personal history of anaphylaxis are significant risk factors.
- Improved diagnostic workup and specialist follow-up are needed.
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