SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

9/14/04

Prevention of anaphylactic reactions to anesthetic drugs

Summary
Background - It is now recognized that anaphylaxis (Ana) in the operative/perioperative period is under-recognized and potentially fatal. Yet the predictors of such reactions and measures to prevent them are not well defined.

Findings - Fisher and Doig of the Univ. of Sydney in Australia reviewed the prevention of Ana reactions to anesthetic agents. They pointed out that many suggested risk factors such as pre-existent atopy and asthma, vasectomy and use of protamine- containing insulin all have theoretical or statistical association with Ana during anesthesia. However, the majority of patients with such a history undergo anesthesia without adverse reaction. Fruit allergy, past history of Ana reactions to penicillin/cephalosporins, and allergy to barbiturates, gelatin, latex and metabisulfite requires consideration in adopting avoidance measures. A particular problem is allergy to quarternary neuromuscular blocking drugs (NMBD). Desensitization and use of monovalent NMBD as a blocking agent may allow use of the usual NMBD with greater safety.

Reference
Drug Saf 2004;27:394-410

Editor's Comments
The co-author of these comments (Dr. Fisher) is a leading expert in allergies to anesthetic agents and peri-operative Ana. Although skin tests are available for agents such as some NMBD, barbiturates, penicillins and latex, there is no straight forward screening method with high degrees of both sensitivity and specificity. One must take a careful history in individuals with convincing histories for peri-operative Ana, remembering that NMBD, beta-lactam antibiotics, and latex are among the most common offenders.

 

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