Dewachter P, Mouton-Faivre C
Inserm U970, service d'anesthésie-réanimation chirurgicale, Samu de Paris, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, France.
Ann Fr Anesth Reanim. 2010 Mar;29(3):215-26. doi: 10.1016/j.annfar.2009.11.014. Epub 2010 Feb 13.
To propose the different modalities of management of the allergic risk occurring during paediatric anaesthesia.
Literature analysis.
Literature research using the Medline((R)) database and MeSH format according to keywords, including publications in French and English since 1982.
The overall incidence for anaphylactic reactions was estimated at one in 7741 anaesthetic procedures during paediatric anaesthesia. Latex anaphylaxis was mostly involved with an incidence at one in 10,159 anesthetic procedures. The risk factors of latex sensitization are known. Primary latex prophylaxis is efficient in patients at risk of latex sensitization. In contrast to adults, neuromuscular blocking agents (NMBAs) are rarely involved in children, with an incidence at 1 in 81,275 anaesthetic procedures. The Ring and Messmer clinical scale allows quantifying the severity and helps managing the care of immediate hypersensitivity reactions. Clinical symptoms associate cardiovascular, respiratory and cutaneous-mucous signs according to different severity grades. Epinephrine associated to fluid loading, remains the first-line agent in case of severe reactions. The allergological assessment is key to the management of these reactions and is required in order to identify the mechanism of the reaction and the culprit drug or substance involved.
Allergic reactions to NMBAs occurring during paediatric anaesthesia are rare whereas those with latex are more frequent. Therefore, the reduction of the allergic risk during paediatric anaesthesia essentially requires a latex-free environment.
提出小儿麻醉期间发生过敏风险的不同管理方式。
文献分析。
使用Medline((R))数据库并按照关键词采用医学主题词表格式进行文献研究，包括自1982年以来的法语和英语出版物。
小儿麻醉期间过敏反应的总体发生率估计为每7741例麻醉手术中有1例。乳胶过敏反应最为常见，发生率为每10159例麻醉手术中有1例。乳胶致敏的危险因素是已知的。原发性乳胶预防对有乳胶致敏风险的患者有效。与成人不同，神经肌肉阻滞剂（NMBAs）在儿童中很少涉及，发生率为每81275例麻醉手术中有1例。Ring和Messmer临床量表可对严重程度进行量化，并有助于管理即刻过敏反应的护理。根据不同严重程度等级，临床症状伴有心血管、呼吸和皮肤黏膜体征。肾上腺素联合液体输注，在严重反应时仍是一线用药。变应性评估是这些反应管理的关键，并且是识别反应机制以及所涉及的致病药物或物质所必需的。
小儿麻醉期间发生的对神经肌肉阻滞剂的过敏反应很少见，而对乳胶的过敏反应更常见。因此，降低小儿麻醉期间的过敏风险主要需要无乳胶环境。
