Incidence of Intraoperative Anaphylaxis in A University General Hospital in Brazil

Abstract

RATIONALE: The epidemiology of intraoperative anaphylaxis is un-known in Brazil. We aimed to evaluate the incidence and clinical features of anaphylaxis during anesthesia in a University General Hospital in Sao Paulo, Brazil. METHODS: A cross-sectional, observational study analyzing data fromvoluntary notification sent by anesthesiologists, about occurrence of intraoperative anaphylaxis during the period between January and December 2010. The diagnostic criteria for anaphylaxis were based onthe World Allergy Organization Guidelines. We analyzed the incidence of intraoperative anaphylaxis, clinical features, severity of anaphylaxis, types of surgical procedures, classification of anesthetic risk (American Society of Anesthesiologists - ASA), culprit agent cited by the anesthesiologist and type of treatment provided. RESULTS: The incidence of intraoperative anaphylaxis was 69:10.000 surgeries. The mean age of patients with anaphylaxis was 36.7 years-old and 57% were women. The most common procedures associated with anaphylaxis were the abdominal non-vascular (17.1%) and urologic (17.1%) surgeries. Skin symptoms were the most prevalent (85.7%) and all patients who presented cardiovascular shock were classified as ASA II (42.9%) or ASA III (57.1%). Epinephrine was used preferentially in anaphylaxis grade 3 (72.7%), while a few patients with anaphylaxis grades 1 and 2 took the drug (2.1% and 16.7, respectively). The most commonly etiologic drugs cited by the anesthesiologists were the neuromuscular blocking agents (22.9%). CONCLUSIONS: Our incidence of intraoperative anaphylaxis was higher than in other studies reported in the literature. These data are a warning signal to encourage measures to reduce the incidence of these severe reactions.