Anaphylaxis in the operating room.
OBJECTIVE
The present article reviews the literature on anaphylactic reactions occurring in the operating room setting. The causes of anaphylaxis are discussed along with the clinical features, treatment and appropriate follow-up for patients who experience this reaction.


RESULTS
Anaphylaxis in the operating room can be caused by IgE-mediated reactions, non-IgE-mediated immunologic reactions as well as nonimmunologic reactions. The most common causes are neuromuscular blocking agents and latex, followed by antibiotics and other induction medications. Reactions may present with severe symptoms such as bronchospasm or cardiovascular collapse. Early recognition, followed by the administration of epinephrine, fluids, oxygen and airway control, is the key to a successful outcome. Follow-up testing, through in-vitro and in-vivo methods, is helpful in determining which agent caused the reaction.


CONCLUSIONS
The management of anaphylaxis in the operating room requires a collaborative effort between anesthesiologists, surgeons and allergists. Protocols for the management of suspected anaphylactic events and subsequent testing should be in place. To prevent future events, patients must receive adequate follow-up and high-risk patients should be identified before they enter the operating room.
Reisacher
William R
WR
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY 10021, USA. wir2011@med.cornell.edu
D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001463:Barbiturates / Q000009:adverse effects; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D020315:Latex Hypersensitivity; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D009873:Operating Rooms; D018570:Risk Assessment; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D001463:Barbiturates; D009466:Neuromuscular Blocking Agents; D007073:Immunoglobulin E