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The purpose of this course is to update nurse anesthetists about anesthetic-induced anaphylaxis. This course discusses the pathophysiologic process of anaphylaxis with descriptions of the allergic immune response and the mediators and mechanisms of mast cell activation. The preoperative identification of patients at high risk and the assessment of potential anesthetic triggers of a hypersensitivity and/or allergic reaction are prudent strategies to minimize the risk of anaphylaxis. Other practices recommended for clinicians include suggestions for anesthetic management to decrease threat of an allergic response in highrisk patients. Furthermore, the identification of the severity grade of hypersensitivity reactions and the appropriate treatment of perioperative anaphylaxis is discussed. In addition, postoperative and follow-up interventions, including testing for patients who have had an anesthetic-induced hypersensitivity reaction, are considered.
Keywords: Anaphylaxis, anesthesia, hypersensitivity reaction, IgE.
Objectives
After completion of this course, the reader should be able to:
1. Recognize the pathophysiologic process of anaphylaxis, its mediators and mechanisms, and the primary cells involved, including mast cells and basophils.
2. Describe the symptoms and determine the severity of anesthetic-induced anaphylaxis.
3. Identify preoperative surgical patients who are at a higher risk for anaphylaxis during anesthesia.
4. Identify anesthetic drugs that may trigger anaphylactic reactions, and examine strategies to prevent perioperative anaphylaxis.
5. Formulate an appropriate treatment protocol for anesthetic-induced anaphylaxis, and suggest the diagnostic tests essential for the evaluation of drug hypersensitivity.
Introduction
Anaphylaxis is a severe allergic reaction that can be life threatening with rapid onset and can occur with or without exposure to a known allergen.1 The incidence during anesthesia ranges from 1 in 4,000 to 1 in 25,000 patients.2 If not promptly diagnosed and treated, a sudden, severe, or prolonged reaction can lead to cardiovascular collapse resulting in perioperative death.3 Anaphylaxis is fatal in 3% to 10% of surgical cases.4 Hypersensitivity to anesthetic drugs remains a substantial hazard for patients at increased risk because it is difficult to promptly recognize; consequently, the proper treatment may be delayed.5 In addition, the lack of specific molecular markers for confirmation of anaphylaxis impedes accurate diagnosis.6 The unreported financial burden resulting from perioperative anaphylaxis may be unknown but substantial; food-induced anaphylaxis costs were more than $500 million in 2007.7
Pathophysiologic Process
* Types of Allergic Reactions. Type I allergic...