Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan.
J Anesth. 2021 Dec;35(6):778-793. doi: 10.1007/s00540-021-03005-8. Epub 2021 Oct 14.
Perioperative anaphylaxis is a severe adverse event during anesthesia that requires prompt diagnosis and treatment by physicians, including anesthesiologists. Muscle relaxants and antibiotics are the most common drugs that cause perioperative anaphylaxis in Japan, as in many countries. In addition, sugammadex appears to be a primary causative agent. Obtaining previous anesthesia records is necessary in a patient with a history of allergic reactions during anesthesia, whenever possible, to avoid recurrence of anaphylaxis. Although medical staff are likely to notice abnormal vital signs because of complete monitoring during anesthesia, surgical drapes make it difficult to notice the appearance of skin symptoms. Even if there are no skin symptoms, anaphylaxis should be suspected, especially when hypotension resistant to inotropes and vasopressors persists. For improving the diagnostic accuracy of anaphylaxis, it is helpful to collect blood samples to measure histamine/tryptase concentrations immediately after the events and at baseline. The first-line treatment for anaphylaxis is adrenaline. In the perioperative setting, adrenaline should be administered through the intravenous route, which has a faster effect onset and is secured in most cases. Adrenaline can cause serious complications including severe arrhythmias if the appropriate dose is not selected according to the severity of symptoms. The anesthesiologist should identify the causative agent after adverse events. The gold standard for identifying the causative agent is the skin test, but in vitro tests including specific IgE antibody measurements and basophil activation tests are also beneficial. The Working Group of the Japanese Society of Anesthesiologists has developed this practical guide to help appropriate prevention, early diagnosis and treatment, and postoperative diagnosis of anaphylaxis during anesthesia.Grade of recommendations and levels of evidence Anaphylaxis is a relatively rare condition with few controlled trials, and thus a so-called evidence-based scrutiny is difficult. Therefore, rather than showing evidence levels and indicating the level of recommendation, this practical guideline only describes the results of research available to date. The JSA will continue to investigate anaphylaxis during anesthesia, and the results may lead to an amendment of this practical guideline.
围手术期过敏反应是麻醉期间发生的严重不良事件，需要麻醉医师（包括麻醉科医生）迅速诊断和治疗。在日本和许多国家一样，肌松剂和抗生素是引起围手术期过敏反应的最常见药物。此外，似乎加巴喷丁是主要的致病药物。在有麻醉期间过敏反应史的患者中，应尽可能获取以前的麻醉记录，以避免过敏反应再次发生。尽管由于麻醉期间的完全监测，医务人员可能会注意到异常生命体征，但手术巾会使皮肤症状难以察觉。即使没有皮肤症状，也应怀疑过敏反应，特别是在对正性肌力药和血管加压素仍然存在低血压的情况下。为了提高过敏反应的诊断准确性，在事件发生后和基线时立即采集血液样本以测量组胺/类胰蛋白酶浓度会有所帮助。过敏反应的一线治疗药物是肾上腺素。在围手术期，肾上腺素应通过静脉途径给药，因为这种途径起效更快，并且在大多数情况下都能得到保障。如果根据症状的严重程度选择合适的剂量，肾上腺素可能会引起严重的并发症，包括严重的心律失常。麻醉医师应在不良事件发生后确定致病药物。识别致病药物的金标准是皮肤试验，但体外试验（包括特异性 IgE 抗体测量和嗜碱性粒细胞活化试验）也有益。日本麻醉学会工作组制定了本实用指南，以帮助在麻醉期间适当预防、早期诊断和治疗以及术后诊断过敏反应。推荐等级和证据水平过敏反应是一种相对罕见的疾病，很少有对照试验，因此很难进行所谓的基于证据的审查。因此，本实用指南没有显示证据水平并表明推荐水平，仅描述了迄今为止可获得的研究结果。JSA 将继续调查麻醉期间的过敏反应，研究结果可能会导致对本实用指南的修订。
