[Anaphylaxis during anaesthesia].
BACKGROUND
Anaphylaxis is a serious life-threatening generalized or systemic hypersensitivity reaction. The aim of this paper is to provide knowledge on how to diagnose, treat and follow up patients with suspected anaphylaxis during general and local anaesthesia.


METHODS
The article is based on literature identified through a non-systematic search in PubMed, the Scandinavian Guidelines on anaphylaxis during anaesthesia and on own research.


RESULTS
Anaphylactic symptoms during anaesthesia vary with respect to severity. Manifestations from skin and the cardiovascular and respiratory systems are present simultaneously in approximately 70 % of patients. Early treatment with adrenaline, fluid and extra oxygen may be vital for survival without sequelae. The following patients should be assessed before anaesthesia: those with moderate or serious reactions or with reactions that raise suspicion of allergy which may cause problems in connection with future treatment. Neuromuscular blocking agents are the main cause of IgE-mediated anaphylaxis during anaesthesia in Norway. New research has shown that allergy towards neuromuscular blocking agents can develop after ingestion of cough syrup containing pholcodine (stimulates asymptomatic production of antibodies). These antibodies cause cross-sensibilisation with neuromuscular blocking agents. The cough syrup Tuxi was withdrawn from the Norwegian market during spring 2007.


CONCLUSIONS
Allergic reactions during anaesthesia are rare and potentially life-threatening; patients should be followed up and treated in a standardized way.
Kirurgisk serviceklinikk, Haukeland universitetssykehus, 5021 Bergen, og, Institutt for kirurgiske fag, Universitetet i Bergen. anne.guttormsen@helse-bergen.no
Anne Berit
AB
Guttormsen
Torkel
T
Harboe
Geert de
Gd
Pater
Erik
E
Florvaag
D000322:Adrenergic Agonists / Q000627:therapeutic use; D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D018681:Anesthetics, General / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D004630:Emergencies; D004837:Epinephrine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D000322:Adrenergic Agonists; D018681:Anesthetics, General; D000779:Anesthetics, Local; D009466:Neuromuscular Blocking Agents; D004837:Epinephrine
Anafylaksi under anestesi.