In the lexicon of perioperative anaphylaxis, colloids and plasma expanders like dextran and hydroxyethyl starch represent a minor 3% of identifiable causes. Sugammadex, since its debut in the European Union in 2008, has notably emerged as a growing concern, with hypersensitivity reactions often occurring swiftly post-administration. Despite extensive use, specific risk factors remain elusive, and severe reactions may necessitate reintubation. Analysis varies, with estimates of anaphylactic reactions ranging significantly across different studies.
Hypnotic induction agents, once accounting for about 2% of perioperative anaphylaxis cases, are seeing a decrease in prevalence. Among these, reactions to barbiturates are dwindling, whereas nonbarbiturates like propofol and benzodiazepines, though rare in causing allergic reactions, remain in use. Propofol, in particular, has evolved in formulation to reduce anaphylactic potential, with modern preparations demonstrating extreme rarity in allergic reactions, even among individuals with specific allergies to egg, peanut, soy, or legume products.
Opioids, commonly associated with cutaneous symptoms like flushing and urticaria post-intravenous administration, rarely escalate to life-threatening reactions, largely manifesting non-IgE-mediated responses.
Latex-induced anaphylaxis, historically significant, has seen a reduction in cases in most countries due to heightened awareness and the adoption of latex-free materials, although it remains a concern in environments still utilizing latex products.
Lastly, there are several agents which contribute to less than 5% of perioperative anaphylaxis incidents, including radiocontrast agents, blood transfusions, preservatives, NSAIDs, and various others, underscoring the wide range of potential triggers within the surgical setting.
