Michalska-Krzanowska Grażyna
Department of Anaesthesiology and Intensive Therapy, 111 Military Hospital in Poznań.
Anaesthesiol Intensive Ther. 2012 Aug 8;44(2):104-11.
Allergy and hypersensitivity occurring during anaesthesia remains a major cause of concern for anaesthesiologists.Drugs administered during surgery and various anaesthetic procedures can elicit two major groups of adverse reactions. The first group includes reactions that are usually dose-dependent and related to the pharmacological properties of a drug and/or its metabolites. The remaining reactions are mostly related to hypersensitivity and allergic responses. They do not depend on specific pharmacology and are usually not dose-dependent.Anaphylaxis is among the most severe of immune-mediated reactions; it generally occurs following re-exposure to specific antigens and release of proinflamatory mediators. The commonest drugs responsible for intraoperative anaphylaxis are muscle relaxants, but latex also accounts for a significant number of incidents, and the frequency of intraoperative latex anaphylactic reactions is increasing. Multiple organ failure, beginning with bronchospasm and cardiovascular collapse, is typical of latex reactions. An increased serum tryptase concentration confirms the diagnosis of an anaphylactic reaction, and triggers can be identified by skin prick, intradermal injection, or serologic testing.The elimination of triggers during subsequent medical episodes is essential to avoid major mortality and morbidity.
麻醉期间发生的过敏和超敏反应仍是麻醉医生主要关注的问题。手术及各种麻醉操作过程中使用的药物可引发两大类不良反应。第一类反应通常与剂量相关，与药物及其代谢产物的药理特性有关。其余反应大多与超敏反应和过敏反应有关。它们不依赖于特定药理学，通常也与剂量无关。过敏反应是最严重的免疫介导反应之一；通常在再次接触特定抗原并释放促炎介质后发生。术中过敏反应最常见的药物是肌肉松弛剂，但乳胶也导致了大量此类事件，且术中乳胶过敏反应的发生率正在上升。以支气管痉挛和心血管虚脱开始的多器官功能衰竭是乳胶反应的典型表现。血清类胰蛋白酶浓度升高可确诊过敏反应，可通过皮肤点刺、皮内注射或血清学检测来确定引发因素。在后续医疗过程中消除引发因素对于避免重大死亡率和发病率至关重要。
