Sir Charles Gairdner Hospital, Nedlands, Australia.
Department of Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
Anaesthesia. 2018 Jan;73(1):32-39. doi: 10.1111/anae.14106. Epub 2017 Nov 2.
Intra-operative acute hypersensitivity reactions require a decision to be made regarding whether to proceed with or abandon the planned surgical procedure once the patient has stabilised. Using retrospective case controls, we examined all cases (223) of proven acute hypersensitivity reactions from 2005 to 2014 in Western Australia, in which the syndrome was recognised by the treating clinician before or during surgery, to determine whether recovery outcomes were adversely affected by proceeding with the planned procedure. Surgery proceeded in 104 patients (47%) and was abandoned in 119 (53%). The severity of acute hypersensitivity reactions was Société Française d'Anesthésie et de Réanimation grade 1 or 2 in 56 patients (25%), grade 3 in 128 (56%) and grade 4 in 39 (17%). Abandoning surgery was more common in patients with increasing severity of hypersensitivity. The rate of major hypersensitivity-related complications for all patients was zero for grade 1 and 2 reactions, 4.7% for grade 3 and 12.8% for grade 4. There were no deaths. Patients in whom surgery was completed were not observed to have a higher frequency of major hypersensitivity-related complications when compared with cases of similar severity in whom surgery was abandoned. For patients admitted to the intensive care unit, proceeding with surgery was not associated with an increased duration of mechanical ventilation of the lungs. Our results suggest that, once initial resuscitation has been achieved and if resuscitative efforts can be re-instituted if required, continuing with planned surgery in grade 1, 2 and 3 immediate hypersensitivity was not associated with poorer outcomes. After grade 3 reactions, there was a significant incidence of complications attributable to acute hypersensitivity regardless of whether surgery proceeded or was abandoned. Surgery was frequently abandoned in grade 4 immediate hypersensitivity and was associated with a high rate of complications.
术中急性过敏反应需要在患者稳定后决定是继续进行还是放弃计划中的手术。我们通过回顾性病例对照研究，检查了 2005 年至 2014 年在西澳大利亚州确诊的 223 例急性过敏反应病例（其中 104 例（47%）继续进行了手术，119 例（53%）放弃了手术），以确定继续进行计划手术是否会对恢复结果产生不利影响。治疗医生在手术前或手术中识别出过敏综合征。223 例患者中，急性过敏反应的严重程度为法国麻醉与复苏学会 1 级或 2 级的 56 例（25%），3 级的 128 例（56%）和 4 级的 39 例（17%）。过敏反应严重程度增加的患者中，放弃手术更为常见。所有患者的主要过敏相关并发症发生率为 1 级和 2 级反应为 0%，3 级反应为 4.7%，4 级反应为 12.8%。无死亡病例。与手术相同严重程度但放弃手术的患者相比，完成手术的患者未观察到更高频率的主要过敏相关并发症。对于入住重症监护病房的患者，继续进行手术与肺部机械通气时间延长无关。我们的结果表明，一旦初始复苏完成，如果需要可以重新进行复苏治疗，在 1 级、2 级和 3 级即刻过敏反应中继续进行计划手术与较差的结果无关。在 3 级反应后，无论是否继续进行手术，都有显著的过敏反应相关并发症发生率。4 级即刻过敏反应时手术经常被放弃，且与高并发症发生率相关。
