Department of Anaesthesiology and Intensive Therapy, Medical University of Bialystok, Białystok, Poland.
Department of Gynecology and Gynecological Oncology, Medical University of Bialystok, Białystok, Poland.
Ann Med. 2021 Dec;53(1):1772-1778. doi: 10.1080/07853890.2021.1976818.
Hypersensitivity reactions are an important aspect of perioperative care and are a crucial interdisciplinary issue in anaesthesiological practice, as well as allergological and laboratory diagnostics. This phenomenon was observed as early as the 1980s and 1990s in Western European countries, and knowledge on this subject has grown significantly over time. Although hypersensitivity reactions are not frequent events (the incidence of perioperative hypersensitivity reactions ranges from 1:386 to 1:13 000 procedures, with higher frequency - 1 per 6500 general anaesthesias with neuromuscular blocking agents administrations), their courses are unfortunately serious and life-threatening. It should also be noted that there is no information regarding the occurrence of perioperative hypersensitivity reactions in many countries. Hence, global assessment of the problem is underestimated. The primary source of actual knowledge comes from epidemiological studies, which indicate an increasing frequency of hypersensitivity reaction occurrence and changes in aetiological factors. The first report from France (1984 to 1989) described two main causes - neuromuscular blocking agents and hypnotic agents. The following years confirmed an increase in perioperative hypersensitivity reactions associated with latex and antibiotics. The most recent data from the National Audit Project 6 indicated increased participation of antibiotics, chlorhexidine, and contrast agents. The results of epidemiological analyses are the basis of medical management guidelines and practice modification. Thanks to the activity of many organisations monitoring the intensity and nature of perioperative hypersensitivity reactions, guidelines for diagnostics and management have been developed. This article presents the results of numerous studies, including the first and the most recent, from various geographical regions. The clinical significance, pathogenesis mechanisms are also discussed. This publication also presents important directions for further scientific and epidemiological research on perioperative hypersensitivity reactions.Key messagesThe incidence of perioperative hypersensitivity reactions ranges from 1:386 to 1:13 000 procedures, with higher frequency - 1 per 6500 general anaesthesias with neuromuscular blocking agents administrations.Reactions may occur during the first episode of anaesthesia, most frequently in the induction of general anaesthesia, and much less frequently during postoperative follow-up.The first reports of perioperative hypersensitivity reaction come from the 1990s, and knowledge on this subject has grown significantly over time.In many countries, multidisciplinary teams and organisations have been established to identify, monitor the occurrence of this phenomenon, and have set the directions of medical activities and have changed the rules and recommendations.There is no information about the occurrence of perioperative hypersensitivity reactions in many countries, and global assessment of the problem is underestimated. Additionally, there is a great need to develop a system to monitor their occurrence in other countries.The long-term epidemiologic studies have demonstrated variability in pharmacologic triggers. However, the main pharmacological substances (antibiotics, muscle relaxants, disinfectans, contrast agents) are related to aspects of patient safety during anaesthesia.
过敏反应是围手术期护理的一个重要方面，也是麻醉学实践、过敏学和实验室诊断中的一个关键跨学科问题。早在 20 世纪 80 年代和 90 年代，西欧国家就观察到了这种现象，并且随着时间的推移，人们对这一主题的了解有了显著的增长。尽管过敏反应并不常见（围手术期过敏反应的发生率为每 386 至 13000 例手术 1 例，使用神经肌肉阻滞剂的全身麻醉中频率更高，为每 6500 例 1 例），但其过程不幸地是严重且危及生命的。还应注意的是，许多国家都没有关于围手术期过敏反应发生的信息。因此，对该问题的全球评估被低估了。实际知识的主要来源是来自于流行病学研究，这些研究表明过敏反应的发生频率和病因因素都在发生变化。法国的第一份报告（1984 年至 1989 年）描述了两个主要原因——神经肌肉阻滞剂和催眠剂。随后的几年证实了与乳胶和抗生素相关的围手术期过敏反应的增加。来自国家审计项目 6 的最新数据表明，抗生素、洗必泰、造影剂的参与度增加。流行病学分析的结果是医疗管理指南和实践修改的基础。由于许多监测围手术期过敏反应强度和性质的组织的活动，已经制定了诊断和管理指南。本文介绍了来自不同地理区域的许多研究的结果，包括最早和最新的研究。还讨论了临床意义、发病机制。本文还提出了围手术期过敏反应进一步科学和流行病学研究的重要方向。
关键信息
围手术期过敏反应的发生率为每 386 至 13000 例手术 1 例，使用神经肌肉阻滞剂的全身麻醉中频率更高，为每 6500 例 1 例。
反应可能发生在第一次麻醉期间，最常见于全身麻醉的诱导期，而在术后随访期间则很少发生。
围手术期过敏反应的第一份报告来自 20 世纪 90 年代，并且随着时间的推移，人们对这一主题的了解有了显著的增长。
在许多国家，已经建立了多学科团队和组织来识别、监测这种现象的发生，并确定了医疗活动的方向，并改变了规则和建议。
许多国家都没有围手术期过敏反应发生的信息，对该问题的全球评估被低估了。此外，迫切需要开发一个系统来监测其他国家的发生情况。
长期的流行病学研究表明，药理触发因素存在可变性。然而，主要的药理物质（抗生素、肌肉松弛剂、消毒剂、造影剂）与麻醉期间患者安全方面有关。
