Perioperative anaphylaxis is rare, even among those at elevated risk, but demands our attention due to its potential severity. The risk factors are multifaceted, including gender-specific responses (notably in females to certain medications), conditions such as mast cell disorders, a history of numerous surgical interventions or procedures (highlighting sensitivities to latex, neuromuscular-blocking agents, and ethylene oxide), and a background of anaphylaxis or allergic reactions including conditions like asthma, eczema, or hay fever. Recent findings identify obesity, higher American Society of Anesthesiologists Physical Status Classification, and the use of beta-blockers or angiotensin-converting enzyme inhibitors as indicators of increased risk for dire outcomes like death or cardiac arrest in the wake of severe perioperative anaphylaxis.
Asthma and chronic obstructive pulmonary disease also mark a heightened risk for fatal anaphylaxis from various causes, with mixed evidence regarding their specific risk for perioperative anaphylaxis. Females, interestingly, are more susceptible than males to reactions from neuromuscular-blocking agents and hypnotic induction agents, a disparity that equalizes before adolescence. A history of adverse reactions to medications nonspecifically amplifies the likelihood of future adverse drug reactions, with multiple past reactions indicating a proportionally greater risk.
Those with a history of numerous surgeries or procedures may face an increased risk for latex allergy and reactions to neuromuscular-blocking agents. Certain surgeries, including transplants and procedures involving the hematologic, cardiac, or vascular systems, have been linked with a higher risk. Patients with mast cell disorders are particularly sensitive to a broad range of stimuli, necessitating specific precautionary measures before any surgical or procedural interventions. This underscores the imperative for anesthesia providers to adopt a vigilant approach to managing patients with known risk factors for perioperative anaphylaxis, tailoring care to mitigate these risks effectively.
