1) The AAGBI has published guidance on management of anaphylaxis during anaesthesia in 1990, 1995 and 2003. This 2008 update was necessary to disseminate new information.
(2) Death or permanent disability from anaphylaxis in anaesthesia may be avoidable if the reaction is recognised early and managed optimally.
(3) Recognition of anaphylaxis during anaesthesia is usually delayed because key features such as hypotension and bronchospasm more commonly have a different cause.
(4) Initial management of anaphylaxis should follow the ABC approach. Adrenaline (epinephrine) is the most effective drug in anaphylaxis and should be given as early as possible.
(5) If anaphylaxis is suspected during anaesthesia, it is the anaesthetist’s responsibility to ensure the patient is referred for investigation.
(6) Serum mast cell tryptase levels may help the retrospective diagnosis of anaphylaxis: appropriate blood samples should be sent for analysis.
(7) Specialist (allergist) knowledge is needed to interpret investigations for anaesthetic anaphylaxis, including sensitivity and specificity of each test used. Specialist (anaesthetist) knowledge is needed to recognise possible non-allergic causes for the ‘reaction’. Optimal investigation of suspected reactions is therefore more likely with the collaboration of both specialties.
(8) Details of specialist centres for the investigation of suspected anaphylaxis during anaesthesia may be found on the AAGBI website http://www.aagbi.org.
(9) Cases of anaphylaxis occurring during anaesthesia should be reported to the Medicines Control Agency and the AAGBI National Anaesthetic Anaphylaxis Database. Reports are more valuable if the diagnosis is recorded following specialist investigation of the reaction.
(10) This guidance recommends that all Departments of Anaesthesia should identify a Consultant Anaesthetist who is Clinical Lead for anaesthetic anaphylaxis.
Suspected Anaphylactic Reactions associated with Anesthesia
Published by The Association of Anaesthetists of Great Britain and Ireland and British Society for Allergy and Clinical Immunology
21 Portland Place, London, W1B 1PY
Telephone: 020 7631 1650, Fax: 020 7631 4352
E-mail: info@aagbi.org Website: www.aagbi.org
Anaphylaxis is a severe life-threatening generalized or systemic hypersensitivity reaction, which can be divided into allergic and non-allergic anaphylaxis. The incidence of anaphylaxis during general anaesthesia is between 1 in 10,000 and 1 in 20,000. Muscle relaxants, antibiotics and intravenous colloids are the most frequent trigger agents. Clinical features of an anaphylactic reaction usually occur within minutes and most commonly include hypotension, bronchospasm or rash.
A suspected anaphylactic reaction is an anaesthetic emergency requiring an ABC approach with specific attention to removal of potential causative agents and titration of adrenaline to symptoms. Secondary management includes chlorphenamine, hydrocortisone, salbutamol, and vasopressors. Anaphylaxis is associated with mast cell degranulation – the subsequent circulating levels of mast cell tryptase can be used to aid diagnosis. All patients with a suspected anaphylaxis reaction should be referred to a specialist allergy or immunology centre for further investigation. The diagnosis is dependent on history, skin tests and blood tests. Following an anaphylactic reaction a letter confirming the diagnosis and outlining a plan for future anaesthesia should be sent to the patient and their general practitioner. The reaction should also be reported to the Medicines and Healthcare Products Regulatory Agency and to the Association of Anaesthetists of Great Britain and Ireland National Anaesthetic Anaphylaxis Database.
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