Department of Pediatrics, University of Verona, Verona, Italy.
Int J Immunopathol Pharmacol. 2011 Jul-Sep;24(3 Suppl):S69-74. doi: 10.1177/03946320110240s310.
Adverse drug reactions or side effects are usually expected, dose dependent, and occur at therapeutic doses. Anaphylactic and anaphylactoid reactions are unexpected and dose independent and can occur at the first exposure to drugs used during anesthesia. Perioperative anaphylaxis is a severe and rapid clinical condition that can be lethal even in previously healthy patients. The initial diagnosis of anaphylaxis is presumptive. A precise identification of the drug responsible for the adverse reaction is more difficult to establish in the case of anaphylactoid reaction because the adverse reaction could result from additive side effects of different drugs injected simultaneously. The timing of the reaction in relation to events, e.g. induction, start of surgery, administration of other drugs, i.v. fluids, is essential for the diagnosis. Generally, reactions are predominant in the induction and recovery phases, and manifested mainly as cutaneous symptoms. Reactions to drugs coincide with the phases when they are administered. Reactions to antibiotics are more frequent in the induction phase, to neuromuscular agents in the initiation and maintenance phases and to non-steroidal anti-inflammatory agents in the recovery phase. The differential diagnosis of any adverse reaction during or following anesthesia should include the possibility of anaphylaxis.
药物不良反应或副作用通常是预期的，与剂量有关，发生在治疗剂量。过敏反应和类过敏反应是不可预测的，与剂量无关，可能发生在第一次接触麻醉期间使用的药物时。围手术期过敏反应是一种严重且迅速的临床情况，即使在以前健康的患者中也可能致命。过敏反应的初步诊断是推测性的。在类过敏反应的情况下，更难以确定导致不良反应的药物，因为不良反应可能是由于同时注射的不同药物的附加副作用引起的。反应与事件的时间关系，例如诱导、手术开始、其他药物的给予、静脉输液，对于诊断至关重要。通常，反应主要发生在诱导和恢复阶段，主要表现为皮肤症状。对药物的反应与给予药物的阶段一致。抗生素类药物的反应更常见于诱导期，神经肌肉阻滞剂的反应见于诱导和维持期，而非甾体类抗炎药的反应见于恢复期。在麻醉期间或之后发生的任何不良反应的鉴别诊断都应包括过敏反应的可能性。
