Introduction
Epidemiology
Intraoperative anaphylaxis
NMBA-induced anaphylaxis
Sugammadex-induced anaphylaxis
Mechanisms
Pholcodine hypothesis
Clinical presentation
Diagnosis
Clinical signs
Anaphylaxis is highly likely when any one of the following three criteria are fulfilled: |
1. Acute onset of an illness (over minutes to several hours) with involvement of the skin, mucosa, or both (e.g., generalized hives, pruritus or flushing, swollen lips-tongue-uvula) |
And at least one of the following |
(a) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia) |
(b) Reduced BP or associated symptoms of end-organ dysfunction [e.g., hypotonia (collapse), syncope, incontinence] |
2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (within minutes to several hours): |
(a) Involvement of the skin-mucosal tissue (generalized hives, itch-flush, swollen lips-tongue-uvula) |
(b) Respiratory compromise (e.g., dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia) |
(c) Reduced BP or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) |
(d) Persistent gastrointestinal symptoms (e.g., cramping abdominal pain, vomiting) |
3. Reduced BP after exposure to a known allergen for that patient (within minutes to several hours): |
(a) Infants and children: low systolic BP (age specific) or greater than 30 % decrease in systolic BPa
|
(b) Adults: systolic BP of less than 90 mmHg or greater than 30 % decrease from that person’s baseline |