Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan.
Intensive Care Unit, Gunma University Hospital, Maebashi, Japan.
Br J Anaesth. 2023 Jul;131(1):170-177. doi: 10.1016/j.bja.2023.02.023. Epub 2023 Mar 24.
Diagnosis of perioperative anaphylaxis is difficult because of its non-specific and variable signs and symptoms. Therapeutic agents used to treat anaphylaxis and anaesthesiologist responses also vary depending on the case, which might affect outcomes; however, only a few studies have focused on these factors.
This prospective study of perioperative anaphylaxis, a part of the Japanese Epidemiologic Study for Perioperative Anaphylaxis, investigated the clinical signs, its severity, therapeutic drugs, epinephrine administration, and anaesthesiologist responses in cases of perioperative anaphylaxis to assess trends and variability. Shock index was used to assess severity of cardiovascular collapse.
In 43 patients analysed in this study, cardiovascular signs (88.4%) were the most frequent, followed by skin (81.4%) and respiratory signs (60.5%). The presence of signs increased during the clinical course. The median time from the first signs to diagnosis of anaphylaxis was 10 (5.0-17.8) min. The rates of epinephrine use were 30.2% (unused), 48.8% (i.v.), and 20.9% (i.m.). The median time from diagnosis of anaphylaxis to epinephrine administration was 7 (inter-quartile range: 1.5-8.0) min. Antihistamines and corticosteroids were each used in 69.8% of cases. The worst shock index was higher in patients who received i.v. epinephrine (2.77 [0.90] mean [standard deviation]) than in both no epinephrine use cases (1.35 [0.41]) and i.m. epinephrine cases (1.89 [0.77] (P<0.001]).
The clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity.
UMIN000035350.
由于围术期过敏反应的症状和体征非特异性且多变，因此其诊断较为困难。用于治疗过敏反应的治疗药物以及麻醉医师的反应也因病例而异，这可能会影响治疗效果；然而，仅有少数研究关注这些因素。
本项前瞻性研究是日本围术期过敏反应流行病学研究的一部分，研究了围术期过敏反应病例的临床体征、严重程度、治疗药物、肾上腺素给药和麻醉医师反应，以评估趋势和变异性。休克指数用于评估心血管衰竭的严重程度。
在本研究分析的 43 例患者中，心血管体征（88.4%）最为常见，其次是皮肤（81.4%）和呼吸体征（60.5%）。体征的出现随时间推移而增加。从首次出现体征到诊断过敏反应的中位时间为 10（5.0-17.8）min。肾上腺素使用率分别为 30.2%（未使用）、48.8%（静脉）和 20.9%（肌肉）。从诊断过敏反应到肾上腺素给药的中位时间为 7（四分位距：1.5-8.0）min。抗组胺药和皮质类固醇分别在 69.8%的病例中使用。接受静脉肾上腺素治疗的患者的最差休克指数（2.77 [0.90] 均数 [标准差]）高于未使用肾上腺素的患者（1.35 [0.41]）和肌肉注射肾上腺素的患者（1.89 [0.77]）（P<0.001）。
围术期过敏反应的临床体征和治疗方法存在差异，肾上腺素给药的选择取决于症状的严重程度。
UMIN000035350。
