Allergic reactions to anaesthesia

[1] An example of a hypersensitivity reaction on the hands from topical anaesthesia.

The incidence of life-threatening hypersensitivity reactions occurring during surgery and anaesthesia is around one in 10,000 procedures.[2] Serious allergic reactions to anesthetic medications are rare and a usually attributable to factors other than the anesthetic. Neuromuscular blocking agents, natural rubber latex, and antibiotics are the most common causes of serious allergic reactions during surgery.[3] The mortality rate from these reactions ranges between 3-9%.[4]

Successful immediate treatment requires prompt recognition by the attending anaesthetist, or in the US, the attending anesthesiologist or nurse anesthetist. Anaesthetists are trained to recognise if an allergic reaction is occurring. The identification of a complication is made by the recognition of issues such as low blood pressure, hives, wheezing, rash, swelling around the eyes or in the mouth and throat and other breathing difficulties.[5] Adrenaline (epinephrine) remains the mainstay of treatment, with corticosteroids and antihistamines providing limited benefit in the acute situation.

Subsequent investigation aims to determine the responsible agent to allow its future avoidance. Skin testing is often useful to identify potentially cross-reactive compounds and appropriate therapeutic alternatives. This is done weeks after the initial reaction to allow the immune system to reset itself. However, skin testing can be misleading in giving false positive and false negative results.

## Anaphylaxis during anaesthesia

Although complications during anaesthesia are rare, potentially life-threatening consequences may occur if an anaphylactic reaction develops. The severity of the reaction whilst under anaesthesia is because the anaesthetist is only made aware of the allergy when it is severe enough to compromise the cardiovascular system and the respiratory system. At this stage, there is little time to manage the situation and recognise the severity of the condition.[6]

The immediate management of the issue consists of three processes:

* The withdrawal of the substances
* Interrupting the effects of the preformed substances released in response to toxin presentation
* Prevention of further substance release

Since the full withdrawal of the offending substance is near impossible, the administration of adrenalin is the main treatment to counteract the effects. Once the patient is stable they will need close observation for 24 hours.[6]

## References

1. ↑ "International Academy of Cosmetic Dermatology". http://www.iacdworld.org/skin/contact.htm.
2. ↑ Mertes, P. M.; Tajima, K.; Regnier-Kimmoun, M. A.; Lambert, M.; Iohom, G.; Guéant-Rodriguez, R. M.; Malinovsky, J. M. (2010-07-01). "Perioperative anaphylaxis". The Medical Clinics of North America 94 (4): 761–789, xi. doi:10.1016/j.mcna.2010.04.002. ISSN 1557-9859. PMID 20609862.
3. ↑ "Anaphylaxis during the perioperative period". Anesthesia and Analgesia 97 (5): 1381–95. 2003. doi:10.1213/01.ANE.0000082993.84883.7D. PMID 14570656.
4. ↑ "World Allergy Organization". http://www.worldallergy.org/professional/allergic_diseases_center/anaesthetic_agents/.
5. ↑ "Possible complications | All About Anaesthesia". http://allaboutanaesthesia.com.au/faqs/possible-complications/.
6. ↑ 6.0 6.1 Dippenaar, JM (March 2015). "Allergic Reactions and Anaphylaxis During Anaesthesia". Current Allergy & Clinical Immunology 28. http://www.allergysa.org/Content/Journals/March2015/Allergic.pdf. Retrieved 16 May 2016.

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Anesthesia and anesthesiology

Types|

* General
* Sedation
* Twilight anesthesia
* Local
* Topical
* Intercostal nerve block
* Neuraxial blockade
* Spinal
* Epidural
* Dental
* Inferior alveolar nerve

Techniques|

* Airway management
* Anesthesia provision in the US
* Arterial catheter
* Bronchoscopy
* Capnography
* Dogliotti's principle
* Drug-induced amnesia
* Intraoperative neurophysiological monitoring
* Nerve block
* Penthrox inhaler
* Tracheal intubation

Scientific principles|

* Blood–gas partition coefficient
* Concentration effect
* Fink effect
* Minimum alveolar concentration
* Second gas effect

Measurements|

* ASA physical status classification system
* Baricity
* Bispectral index
* Entropy monitoring
* Fick principle
* Goldman index
* Guedel's classification
* Mallampati score
* Neuromuscular monitoring
* Thyromental distance

Instruments|

* Anaesthetic machine
* Anesthesia cart
* Boyle's machine
* Gas cylinder
* Laryngeal mask airway
* Laryngeal tube
* Medical monitor
* Odom's indicator
* Relative analgesia machine
* Vaporiser
* Double-lumen endotracheal tube
* Endobronchial blocker

Complications|

* Emergence delirium
* Allergic reactions
* Anesthesia awareness
* Local anesthetic toxicity
* Malignant hyperthermia
* Perioperative mortality
* Postanesthetic shivering
* Postoperative nausea and vomiting
* Postoperative residual curarization

Subspecialties|

* Cardiothoracic
* Critical emergency medicine
* Geriatric
* Intensive care medicine
* Obstetric
* Oral sedation dentistry
* Pain medicine

Professions|

* Anesthesiologist
* Anesthesiologist assistant
* Nurse anesthetist
* Operating department practitioners
* Certified Anesthesia Technician
* Certified Anesthesia Technologist
* Anaesthetic technician
* Physicians' assistant (anaesthesia)

History|

* ACE mixture
* Helsinki Declaration for Patient Safety in Anaesthesiology
* History of general anesthesia
* History of neuraxial anesthesia
* History of tracheal intubation

Organizations|

* American Association of Nurse Anesthetists
* American Society of Anesthesia Technologists & Technicians
* American Society of Anesthesiologists
* Anaesthesia Trauma and Critical Care
* Association of Anaesthetists of Great Britain and Ireland
* Royal College of Anaesthetists
* Association of Veterinary Anaesthetists
* Australian and New Zealand College of Anaesthetists
* Australian Society of Anaesthetists
* International Anesthesia Research Society

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