Mm. Fisher et Ba. Baldo, THE INCIDENCE AND CLINICAL-FEATURES OF ANAPHYLACTIC REACTIONS DURING ANESTHESIA IN AUSTRALIA, Annales francaises d'anesthesie et de reanimation, 12(2), 1993, pp. 97-104
The details of 826 patients referred to an Anaesthetic Allergy Clinic
over a 17-year period are described. 443 were classified as having sev
ere immediate anaphylactic reactions and in the majority of these (263
) a muscle relaxant was involved. In Australia, the most common cause
of a reaction is alcuronium, which probably reflects usage, although i
t is the most commonly found to give a positive skin test in relaxant
reactors. Suxamethonium and atracurium appear to have an incidence of
reactions greater than predicted by market share and pancuronium and v
ecuronium appear safer both on incidence of reactions and on positive
skin tests in reactors. The incidence of reactions is between 1 :10,00
0 and 1 :20,000 anaesthetics. Patients who react have greater incidenc
e of allergy, atopy, asthma and previous reactions than non reactors.
Previous exposure is usually apparent in reactors to induction agents
but not muscle relaxants. Cardiovascular collapse is the most common p
resenting problem and is the only problem in 10 %. Skin changes are th
e next most common and then bronchospasm which may be transient and is
the hardest feature to treat. With an investigation protocol based on
history, skin and RIA testing subsequent anaesthesia is usually safe.