title: Treatment with epinephrine (adrenaline) in suspected anaphylaxis during anesthesia in Denmark.
abstract: BACKGROUND
  Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important.
  
  
  METHODS
  A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted.
  
  
  RESULTS
  A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min after onset of hypotension as early, and more than 10 min as late, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35).
  
  
  CONCLUSIONS
  Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence. Anaphylaxis should be considered and treated in patients with circulatory instability during anesthesia of no apparent cause who do not respond to the usual treatments.
authors.affiliation: Danish Anaesthesia Allergy Centre, Allergy Clinic KAA-816, Department of Dermato-Allergology, Copenhagen University Hospital, Gentofte Hospital, and Department of Anaesthesia, Centre for Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark. lene@heisegarvey.dk
authors.forename: Lene H
authors.initials: LH
authors.lastname: Garvey
authors.forename: Bo
authors.initials: B
authors.lastname: Belhage
authors.forename: Mogens
authors.initials: M
authors.lastname: Krøigaard
authors.forename: Bent
authors.initials: B
authors.lastname: Husum
authors.forename: Hans-Jørgen
authors.initials: HJ
authors.lastname: Malling
authors.forename: Holger
authors.initials: H
authors.lastname: Mosbech
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000150:complications / Q000188:drug therapy*; D000758:Anesthesia / Q000009:adverse effects*; D003718:Denmark; D004363:Drug Utilization; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012769:Shock / Q000150:complications / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine