Kroigaard M, Garvey L H, Gillberg L, Johansson S G O, Mosbech H, Florvaag E, Harboe T, Eriksson L I, Dahlgren G, Seeman-Lodding H, Takala R, Wattwil M, Hirlekar G, Dahlén B, Guttormsen A B
Danish Anaesthesia Allergy Centre, Department of Anaesthesia, Section 4231 Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2007 Jul;51(6):655-70. doi: 10.1111/j.1399-6576.2007.01313.x.
The present approach to the diagnosis, management and follow-up of anaphylaxis during anaesthesia varies in the Scandinavian countries. The main purpose of these Scandinavian Clinical Practice Guidelines is to increase the awareness about anaphylaxis during anaesthesia amongst anaesthesiologists. It is hoped that increased focus on the subject will lead to prompt diagnosis, rapid and correct treatment, and standardised management of patients with anaphylactic reactions during anaesthesia across Scandinavia. The recommendations are based on the best available evidence in the literature, which, owing to the rare and unforeseeable nature of anaphylaxis, mainly includes case series and expert opinion (grade of evidence IV and V). These guidelines include an overview of the epidemiology of anaphylactic reactions during anaesthesia. A treatment algorithm is suggested, with emphasis on the incremental titration of adrenaline (epinephrine) and fluid therapy as first-line treatment. Recommendations for primary and secondary follow-up are given, bearing in mind that there are variations in geography and resources in the different countries. A list of National Centres from which anaesthesiologists can seek advice concerning follow-up procedures is provided. In addition, an algorithm is included with advice on how to manage patients with previous suspected anaphylaxis during anaesthesia. Lastly, Appendix 2 provides an overview of the incidence, mechanisms and possibilities for follow-up for some common drug groups.
在斯堪的纳维亚国家，目前针对麻醉期间过敏反应的诊断、管理及随访方法存在差异。这些斯堪的纳维亚临床实践指南的主要目的是提高麻醉医生对麻醉期间过敏反应的认识。希望对该主题的更多关注将促使整个斯堪的纳维亚地区对麻醉期间发生过敏反应的患者进行快速诊断、迅速且正确的治疗以及标准化管理。这些建议基于文献中现有的最佳证据，由于过敏反应的罕见性和不可预测性，主要包括病例系列和专家意见（证据等级为IV和V）。这些指南包括麻醉期间过敏反应的流行病学概述。提出了一种治疗算法，重点是将肾上腺素增量滴定和液体疗法作为一线治疗方法。给出了一级和二级随访的建议，同时考虑到不同国家在地理和资源方面存在差异。提供了一份国家中心名单，麻醉医生可从中寻求有关随访程序的建议。此外，还纳入了一种算法，提供有关如何管理麻醉期间曾疑似发生过敏反应患者的建议。最后，附录2概述了一些常见药物组的发生率、机制及随访可能性。
