Perioperative Anaphylaxis

Anesthesiologists routinely manage patients in multiple clinical settings, including surgery, intensive care, procedural interventions, and/or trauma. In these settings, patients receive a variety of drugs, blood products, or imaging agents, all of which have the potential for adverse reactions, including immediate hypersensitivity reactions. Because the most life-threatening presentation of an immediate hypersensitivity reaction is anaphylaxis, clinicians must be ready to diagnose and manage the life-threatening cardiopulmonary dysfunction that can occur. In the perioperative setting, patients may be under the effects of general or regional anesthesia, or, in the intensive care unit, patients may be sedated and mechanically ventilated with potential causes for hypotension and complicate making the diagnosis. In this review, we will examine the incidence, pathophysiology, presentations, and acute management of perioperative anaphylaxis.

Anaphylaxis is the most severe form of immediate hypersensitivity reaction due to the massive release of multiple physiologically active mediators by inflammatory cells. In immunoglobulin E–mediated...