• Yuki Sugiyama, Tomonori Takazawa, Natsuko Watanabe, Kiyoko Bito, Tetsuhiro Fujiyoshi, Shinsuke Hamaguchi, Takashi Haraguchi, Tatsuo Horiuchi, Yoshinori Kamiya, Noboru Maruyama, Hitoshi Masumo, Harumasa Nakazawa, Kazuhiro Nagumo, Masaki Orihara, Jun Sato, Kenichi Sekimoto, Kenichiro Takahashi, Mutsumi Uchiyama, Kazunobu Takahashi, Masao Yamaguchi, and Mikito Kawamata.
• Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan.
• Br J Anaesth. 2023 Jul 1; 131 (1): 170177170-177.

BackgroundDiagnosis of perioperative anaphylaxis is difficult because of its non-specific and variable signs and symptoms. Therapeutic agents used to treat anaphylaxis and anaesthesiologist responses also vary depending on the case, which might affect outcomes; however, only a few studies have focused on these factors.MethodsThis prospective study of perioperative anaphylaxis, a part of the Japanese Epidemiologic Study for Perioperative Anaphylaxis, investigated the clinical signs, its severity, therapeutic drugs, epinephrine administration, and anaesthesiologist responses in cases of perioperative anaphylaxis to assess trends and variability. Shock index was used to assess severity of cardiovascular collapse.ResultsIn 43 patients analysed in this study, cardiovascular signs (88.4%) were the most frequent, followed by skin (81.4%) and respiratory signs (60.5%). The presence of signs increased during the clinical course. The median time from the first signs to diagnosis of anaphylaxis was 10 (5.0-17.8) min. The rates of epinephrine use were 30.2% (unused), 48.8% (i.v.), and 20.9% (i.m.). The median time from diagnosis of anaphylaxis to epinephrine administration was 7 (inter-quartile range: 1.5-8.0) min. Antihistamines and corticosteroids were each used in 69.8% of cases. The worst shock index was higher in patients who received i.v. epinephrine (2.77 [0.90] mean [standard deviation]) than in both no epinephrine use cases (1.35 [0.41]) and i.m. epinephrine cases (1.89 [0.77] (P<0.001]).ConclusionsThe clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity.Clinical Trial RegistrationUMIN000035350.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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