Department of Anaesthesia, University Hospital Bristol, Bristol, UK.
Department of Anaesthesia and Pain Medicine, St. John of God Murdoch Hospital, Perth, Western Australia.
Anaesthesia. 2018 Jan;73 Suppl 1:76-84. doi: 10.1111/anae.14143.
Adverse drug reactions are a cause of significant morbidity and mortality to patients and a source of financial burden to the healthcare system. Of the wide spectrum of adverse drug reactions, the most concerning to the anaesthetist remain anaphylaxis and malignant hyperthermia. Although the incidence of anaphylaxis under anaesthesia is difficult to ascertain, it occurs commonly enough that most anaesthetists will manage at least one case in their career. The wide range of drugs given in the peri-operative period and the variable presentation in the anaesthetised patient can delay diagnosis and treatment, and adversely affect outcome. Furthermore, despite improvements in testing, causative drugs can still be difficult to identify, as adverse reactions may be mediated by mechanisms other than IgE activation. With an increase in the reporting of anaphylaxis to newer anaesthetic drugs such as sugammadex, combined with change over the recent decades in the most likely causative peri-operative agents, it is imperative anaesthetists remain up to date on recent developments. In addition, they should be vigilant to patient characteristics, including pharmacogenetic variations that may predispose to adverse drug reactions, in order to help minimise risks of a reaction. The severity of adverse drug reactions to peri-operative drugs means morbidity and mortality remain high.
药物不良反应是导致患者发病率和死亡率显著增加的原因，也是医疗保健系统财政负担的来源。在广泛的药物不良反应中，麻醉医师最关注的仍然是过敏反应和恶性高热。尽管麻醉期间过敏反应的发生率难以确定，但它的发生频率相当高，以至于大多数麻醉医师在职业生涯中至少会处理一例。围手术期使用的药物种类繁多，麻醉患者的表现也各不相同，这可能会导致诊断和治疗延迟，从而对结果产生不利影响。此外，尽管测试有所改进，但仍然很难确定致病药物，因为不良反应可能是由 IgE 激活以外的机制介导的。随着向新型麻醉药物（如 sugammadex）报告过敏反应的增加，再加上最近几十年来最有可能导致围手术期发生的药物发生变化，麻醉医师必须了解最新的发展动态。此外，他们应该对患者的特征保持警惕，包括可能导致药物不良反应的药物遗传学差异，以帮助尽量降低不良反应的风险。围手术期药物不良反应的严重程度意味着发病率和死亡率仍然很高。
