Updates in IntraoperativeAnaphylaxis

Abstract

Anaphylaxisisapotentiallylethalreactionresultingfromthesudden,clinicallysignificantreleaseofmastcell-and/orbasophil-derivedmediatorsintothecirculation.BothIgE-andnonIgE-mediatedmechanismshavebeenimplicated,andsomeagentsmaycausereactionsbymorethanonemechanism. Themostcommonidentifiablecausesofintraoperativeanaphylaxisareneuromuscularblockingagents(NMBAs),antibiotics,latex,hypnoticinductionagents(primarilybarbiturates),opioids,andcolloids.However,thereisamuchlongerlistofagentsthatareimplicatedlessregularly Riskfactorsincludeasthma,femalesex(forcertainmedications),otherallergicconditionssuchaseczemaorhayfever,multiplepastsurgeriesorprocedures(especiallyforlatex),andmastcelldisordersincludingmastcellactivationsyndrome,monoclonalmastcellactivationsyndrome,andsystemicmastocytosis. Intraoperativeanaphylaxispresentswithcutaneous,respiratory,andcardiovascularsignsandsymptoms,aswellasvariableinvolvementofotherorgansystems.One-halfofcasesareinitiallydetectedassuddencardiovascularcollapse.Bronchospasmmaypresentasanincreaseintheventilatorypressurerequiredtoinflatethelungsorasadecreaseinarterialoxygensaturation.