Allergic reactions during anaesthesia

The incidence of life-threatening hypersensitivity reactionsoccurring during anaesthesiais around one in 10,000 procedures. Muscle relaxantsare involved in over two thirds of the cases. Antibiotic administration is a frequent cause.

The mortality rate from these reactions is about 3-6%.

Successful immediate treatment requires prompt recognition by the attending anaesthetist. Adrenaline(epinephrine) remains the mainstay of treatment, with corticosteroidsand antihistaminesproviding limited benefit in the acute situation.

Subsequent investigation aims to determine the responsible agent to allow its future avoidance. Skin testingis often useful to identify potentially cross-reactive compounds and appropriate therapeutic alternatives. This is done weeks after the initial reaction to allow the immune system to reset itself. However, skin testing can be misleading in giving false positive and false negative results.

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