Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions

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Citações na Scopus
1
Tipo de produção
article
Data de publicação
2018
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ISSN da Revista
Título do Volume
Editora
HOSPITAL CLINICAS, UNIV SAO PAULO
Citação
CLINICS, v.73, article ID UNSP e287, 7p, 2018
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Resumo
OBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of Sao Paulo School of Medicine, Hospital das Clinicas, Sao Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.
Palavras-chave
Anaphylaxis, Anesthesia, Drug Allergy, Intraoperative, Questionnaire
Referências
  1. Aun MV, 2014, J ALLER CL IMM-PRACT, V2, P826, DOI [10.1016/j.jaip.2014.08.015, 10.1016/j.jaip.2014.03.014]
  2. Demoly P, 2014, ALLERGY, V69, P420, DOI 10.1111/all.12350
  3. Dewachter P., 2007, DRUG HYPERSENSITIVIT, P2004
  4. Faria E, 2008, REV PORT IMUNOALERG, V16, P73
  5. Galvao VR, 2014, CURR ALLERGY ASTHM R, V14, DOI 10.1007/s11882-014-0452-6
  6. Harper NJN, 2009, ANAESTHESIA, V64, P199, DOI 10.1111/j.1365-2044.2008.05733.x
  7. Laxenaire MC, 1999, ANN FR ANESTH, V18, P796, DOI 10.1016/S0750-7658(00)88460-9
  8. Levy JH, 2011, ANESTH ANALG, V113, P979, DOI 10.1213/ANE.0b013e31822d68a5
  9. Liew WK, 2009, J ALLERGY CLIN IMMUN, V123, P434, DOI 10.1016/j.jaci.2008.10.049
  10. Mertes PM, 2011, J INVEST ALLERG CLIN, V21, P442
  11. Mertes PM, 2009, IMMUNOL ALLERGY CLIN, V29, P429, DOI 10.1016/j.iac.2009.04.004
  12. Mertes PM, 2011, J ALLERGY CLIN IMMUN, V128, P366, DOI 10.1016/j.jaci.2011.03.003
  13. Mertes PM, 2005, J INVEST ALLERG CLIN, V15, P91
  14. Mertes PM, 2003, ANESTHESIOLOGY, V99, P536, DOI 10.1097/00000542-200309000-00007
  15. Morais-Almeida M, 2007, REV PORT IMUNOALERG, V15, P19
  16. Saager L, 2015, ANESTHESIOLOGY, V122, P551, DOI 10.1097/ALN.0000000000000529
  17. Simons FER, 2014, WORLD ALLERGY ORGAN, V7, DOI 10.1186/1939-4551-7-9
  18. Simons FER, 2011, J ALLERGY CLIN IMMUN, V127, P587, DOI 10.1016/j.jaci.2011.01.038