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Perioperative anaphylactic reactions to central venous and pulmonary artery catheters containing chlorhexidine, sulfadiazine, or latex: a historical cohort study
CONCLUSION: Perioperative anaphylactic reactions related to CVCs/PACs containing chlorhexidine, silver sulfadiazine, or latex were rare in this large historical cohort study. We identified 2,937 patients with pre-existing chlorhexidine, sulfa, and/or latex allergies and had CVCs/PACs inserted that contained these substances. Although few cases of perioperative anaphylaxis attributable to these substances were observed in patients with corresponding allergies, the potential for substantial complication exists. Providers should be aware of the potential for these hidden exposures.PMID:36829103 | DOI:10.1007/s12630-023-02403-8
Source: Canadian Journal of Anaesthesia - February 24, 2023 Category: Anesthesiology Authors: Terrique M Pinnock Gerald W Volcheck Mark M Smith Andrew W Murray Johnathan R Renew Bradford B Smith Source Type: research

Severe Polyethylene Glycol Allergy Considerations for Perioperative Management: A Case Report
We present a patient with known past anaphylactic reaction to PEG and a detailed account of her perioperative course. More broadly, we provide recommendations and resources for the safe management of similar patients with a severe PEG allergy.
Source: A&A Case Reports - October 1, 2022 Category: Anesthesiology Tags: Perioperative Management/Medicine Source Type: research

Practical Management of New-Onset Urticaria and Angioedema Presenting in Primary Care, Urgent Care, and the Emergency Department
Perm J. 2021 Nov 22;25. doi: 10.7812/TPP/21.058.ABSTRACTA new episode of urticaria and/or angioedema can be an anxiety-inducing event for both the patient and the physician(s) seeing them in primary care, urgent care, or the emergency department. These events are commonly mistaken for "allergic" reactions and often mistreated. The most common causes of new onset urticaria in older children and adults, with or without angioedema, and normal vital signs or hypertension, are post-infection or acute idiopathic urticaria. These patients are not helped by systemic steroids, which may cause morbidity. An IgE-mediated allergy is a...
Source: Pain Physician - March 29, 2022 Category: Anesthesiology Authors: Eric Macy Source Type: research

End-tidal Carbon Dioxide for Diagnosing Anaphylaxis in Patients with Severe Postinduction Hypotension
ConclusionsIn case of severe hypotension after anesthesia induction, a low ETco2 contributes to the diagnosis of anaphylaxis, in addition to the classical signs of perioperative immediate hypersensitivity.Editor ’s PerspectiveWhat We Already Know about This TopicAnaphylaxis in the anesthetized patient can be challenging to diagnose as hypotension, the most common manifestation, has multiple causes postinduction. In addition to hypotension, low end-tidal carbon dioxide has also been suggested to be helpful in the diagnosis.What This Article Tells Us That Is NewFrom a retrospective single-center case-control study comparin...
Source: Anesthesiology - February 9, 2022 Category: Anesthesiology Source Type: research

Remimazolam anaphylaxis during anesthesia induction
We report a 32-year-old man who developed anaphylaxis during induction of general anesthesia with remimazolam for hand surgery. He received general anesthesia with midazolam 4 weeks before. This time facial flushing followed by a decrease of peripheral oxygen saturation (SpO2) and blood pressure occurred 2  min after starting continuous remimazolam infusion at 6 mg/kg/h. Hypotension and SpO2 were recovered by repeated administration of adrenaline. Despite no increase of serum tryptase levels, intradermal allergy tests 4  weeks postoperatively revealed that remimazolam and midazolam were positive, suggesting remimazolam...
Source: Journal of Anesthesia - July 24, 2021 Category: Anesthesiology Source Type: research

Sugammadex and anaphylaxis: An analysis of 33 published cases
In this study, the published sugammadex-induced anaphylaxis reports were reviewed to determine similarities in their presentation during anesthesia. PubMed was searched for sugammadex-induced anaphylaxis without time limitation. Reports were evaluated if they were in English and met the criteria of anaphylaxis determined by the World Allergy Organization. Two independent reviewers extracted and assessed the data using predesigned data collection forms. In total, 23 suitable articles were found and 33 sugammadex-induced anaphylaxis cases were included in the study. The mean age was 43.09 years (from 3–89 years)...
Source: Journal of Anaesthesiology Clinical Pharmacology - July 15, 2021 Category: Anesthesiology Authors: Baris Arslan Tuna Sahin Hatice Ozdogan Source Type: research

Potential Patent Blue V Overdose in a Patient Undergoing Free-Flap Breast Reconstruction: A Case Report
The case of a patient who experienced serious adverse effects following a potential overdose of Patent Blue V dye (PVB) is presented here. A 65-year-old woman developed cardiac arrythmias and circulatory instability 35 minutes after receiving 100 mg PVB during breast cancer surgery. An allergic reaction was assumed and treated accordingly. Intraoperatively, both epinephrine and norepinephrine infusions were required to support circulation. However, mast-cell tryptase levels were normal and subsequent allergy testing for all potential allergens was negative. This case highlights that life-threatening reactions to perioperat...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Food Allergy History and Reaction to Propofol Administration in a Large Pediatric Population.
CONCLUSIONS: In the listed food-allergic cohort, the majority had no allergy testing or negative testing. We found no evidence of a relationship between food allergy history and perioperative propofol reaction. We suggest multiply allergic and atopic patients may have a similar likelihood of propofol reaction as with other medications. PMID: 33529424 [PubMed - as supplied by publisher]
Source: Paediatric Anaesthesia - February 2, 2021 Category: Anesthesiology Authors: Bagley L, Kordun A, Sinnott S, Lobo K, Cravero J Tags: Paediatr Anaesth Source Type: research

Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis.
Authors: Solé D, Spindola MAC, Aun MV, Araújo Azi LMT, Bernd LAG, Garcia DB, Capelo AV, Cumino DO, Lacerda AE, Lima LC, Morato EF, Nunes RR, Rubini NPM, da Silva J, Tardelli MÂ, Watanabe AS, Curi EF, Sano F Abstract This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment...
Source: Revista Brasileira de Anestesiologia - December 16, 2020 Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research

Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment.
Authors: Spindola MAC, Solé D, Aun MV, Azi LMTA, Bernd LAG, Garcia DB, Capelo AV, Cumino DO, Lacerda AE, Lima LC, Morato EF, Nunes RR, Rubini NPM, da Silva J, Tardelli MÂ, Watanabe AS, Curi EF, Sano F Abstract Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to re...
Source: Revista Brasileira de Anestesiologia - October 22, 2020 Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research

Perioperative anaphylaxis: diagnostic challenges and management
Purpose of review Perioperative hypersensitivity reactions can pose diagnostic and management challenges for the anaesthetist. Difficulties in diagnosing hypersensitivity reactions in the perioperative setting are highlighted and recommendations from recent guidelines on the acute management of life-threatening anaphylaxis are presented. Recent findings Anaesthetists play a key role in investigating perioperative hypersensitivity reactions. During a suspected perioperative hypersensitivity event, a serum tryptase level should be measured to help with subsequent allergy investigation. Moreover, anaesthetists can ensure...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

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