Anaesthetic allergy: Overview

Abstract
A 13-year-old otherwise healthy girl underwent general anesthesia for the first time in her life for an elective surgery to treat a meniscus injury. During surgery, she experienced anaphylactic shock and the surgery was immediately terminated. Subsequent allergy screening for rocuronium, chlorhexidine, povidone-iodine, and latex yielded all negative results. She was referred to our hospital for diagnosis of a causal agent. A challenge test was performed in the operating room for the following 5 drugs: fentanyl, sevoflurane, rocuronium, propofol, and remifentanil. Anaphylactic symptoms occurred with only sevoflurane. This is the first report of a confirmed sevoflurane allergy.

Abstract in English, French
Purpose: In this Continuing Professional Development module, we provide a framework for the prompt diagnosis and management of perioperative anaphylaxis.

Principal findings: Anaphylaxis in the perioperative period can lead to sudden cardiorespiratory compromise. Hypotension, tachycardia, and bronchospasm are the most common presenting signs of anaphylaxis; however, they are nonspecific, making diagnosis challenging. Associated factors that support a diagnosis of anaphylaxis include the timing of symptom onset, a lack of response to first-line vasopressors, evidence of severe hypovolemia, and the appearance of a rash. Treatment should not be delayed in the absence of cutaneous findings, as hemodynamic compromise is often the main presenting feature. Appropriate treatment involves administering epinephrine, resuscitating with fluids, protecting the airway, and removing any triggering agents.

Conclusions: Anaphylaxis is a challenge to diagnose and clinically manage in the perioperative period. Provider vigilance, a high index of suspicion, and timely treatment are necessary to ensure the successful resuscitation and safety of the patient.