M C Laxenaire, P M Merte Groupe d'E...

M C Laxenaire, P M Merte Groupe d'Etude de Reactions Anaphylactoides Peranesthesiques British Journal of Anaesthesia Vol 87 (October 2001) 549-558

Perioperative supply with nourishments must be prepared for emergencies, nevertheless with increasing pressure to be more efficient and do more with les they may question whether and when it is a priority to be prepared for an intraoperative conjuncture Researchers in a network of 38 French health care facilities examined the issue of undivided intraoperative emergency (ie, anaphylaxis) and identified triggering agents.

arrangements Researchers used a retrospective descriptive design to investigate anaphylactic reactions that occurr during anesthesia. The sample consisted of patients who had an anaphylactic reaction during anesthesia between Jan 1 1997 and Dec 31 1998 Four hundr seventy-seven patients enlisted in the study. Diagnosis was established using standardized criteria, including clinical history, cutaneous ordeals and/or specific immunoglobulin-E (IgE) assay.

A questionnaire solicited demographic data, allergy history, anesthetic history, date of anaphylactic reaction, and medications administered before the reaction occurr Reactions were graded from I to IV depending upon severity (ie, I = cutaneous symptoms alone; II = measurable however not life-threatening symptoms; III = life-threatening reactions; IV = circulatory inefficacy, cardiac, and/or respiratory arrest). Information from allergy experiments was recorded systematically, and cutaneous experiments were performed. The presence of specific IgE against muscle relaxants was investigated using radioimmunoassay (RIA). In vitro testing for latex-specific IgE was performed using a radio-allergosorbent ordeal Researchers measured plasma levels of histamine with commercially available RIA kits.

To compare the incidence of anaphylaxis to available neuromuscular blocking agents, the quantity of agents sold in France in 1997 and 1998 was obtained from pharmaceutical companies. The number of vials used effectively in anesthesia was estimated based in succession a market survey. To determine the number of patients effectively expos to each agent, a correction factor was applied based in succession the average number of vials used by anesthetic.

Results. Of the 477 participants, the majority were female (727%) Anaphylaxis springed from exposure to 30 different substances, all of which are used routinely in France. Muscle relaxants were the most numerous common cause (n = 336 692%) The number of cases (n = 98) resulting from rocuronium was higher than its relative common occurrence of use in anesthesia. Natural rubber latex was the other leading cause (n = 59 121%) followed by means of antibiotics (n = 39, 80%) Review of medical records identified evidence of an adverse reaction during previous anesthetic performances in five participants.

principally adverse reactions were either grade II (229%) or grade III (626%) The majority (696%) included near cutaneous symptoms. Angioedema was seen in 117% of cases. Participants also experienced respiratory and cardiovascular rejoinders including cardiovascular collapse and bronchospasm. exact complications included transient renal failure, coma or persistent vegetative state, hemiplegia, and neurological damage to the fetus of a pregnant patient.

Discussion. common strength of this study is the multicenter approach. This broader perspective provides a greater potential for generalizability of the findings. The ability to definitively determine what triggered an anaphylactic reaction is to a high degree important to avoid further reactions. The use of a standardized grading scale is another hardness The evidence that five population had previous reactions during anesthesia further supports the importance of preoperative assessments.

common limitation involves comparing the number of reactions associated with different agents. Ideally, a rate of reactions by dose administered would provide the best scientific information. This is excessively difficult to achieve in clinical practice. Researchers calculated a comparison based in succession an approximation of doses administered; although not as healthy this level of evidence is adequate for perioperative encourages responsible for patient care.

Nursing implications. All perioperative fosters should be prepared to manage anaphylaxis in the OR. Medications and supplies to treat a reaction should be kept onward hand. Nurses should be familiar with the principally likely triggering agents, and they should be readily available, particularly during administration of muscle relaxants, to help the anesthesia care provider manage an emergency

secondary to muscle relaxants, latex is the agent principally likely to trigger an anaphylactic reaction. If anaphylaxis arises and muscle relaxants have not been administered, surgical team members should change to nonlatex glove before proceeding. This measure could interrupt further exposure should the triggering agent be latex.

This application of mind also provides direction for perioperative educators. Basic orientation should include information about triggering agents. A comprehensive understanding will heighten awareness during the administration of these agents. testing should include questions about the in the greatest degree frequent triggering agents.