The cause of perioperative hypersensitivity in adults and consequences of subsequent anesthesia

Abstract

Background: In the perioperative period, patients are exposed to many agents that may cause hypersensitivity reaction; so, finding the culprit drug is important for patient safety in the event of the need for repeat anesthesia.

Aim: Our aim was to share demographic data, clinical features, and diagnostic tests of patients who developed perioperative hypersensitivity (POH) and in whom the culprit drug was identified.

Methods: Patients evaluated for POH between 2016 and 2024 were retrospectively analyzed. Results of anesthesia notes, agents used in anesthesia, skin prick test, and intradermal test (IDT) to determine the culprit drug were examined. Patients were interviewed by telephone and questioned about their reanesthesia status.

Results: The files of 167,688 patients were analyzed; 405 patients were referred and tested for POH and 330 patients were excluded from the study because they had no history of POH or the culprit drug could not be identified. The study was completed with 75 patients. POH developed during the induction of anesthesia (I) in 18, maintenance (M) in 34, and at the end (E) in 23 patients. The median age was 48, out of which 89.3% (n = 67) were females. Reactions developed during genitourinary system surgery in 33.3% (n = 25), ear-nose-throat surgery in 17.3% (n = 13), and abdominal surgery in 17.3% (n = 13); anaphylaxis developed in 56% (n = 42) (I: 9; M: 21; E: 12); cutaneous involvement in 73.3% (n = 55); cardiovascular involvement in 41.3% (n = 31), respiratory system involvement in 56% (n = 42), and gastrointestinal involvement in 4% (n = 3); Brown grade 1 in 44% (n = 33) and grade 3 in 38.7% (n = 29); Ring and Messmer classification, grade 1 in 44% (n = 33); and cardiac arrest in five patients. For the distribution of culprit drugs: neuromuscular blocking agents (NMBAs) in 22.7%, opioids in 21.4%, hypnotics in 17.3%, and antibiotics in 14.6%. In four patients, multiple agents were determined. Skin prick test was positive in 35.1% and IDT positivity was found in 98.6%. Surgery was cancelled in 40% (n = 30), but it was determined that 50 patients (66.7%) underwent surgery after drug tests. All of them tolerated surgery.

Conclusıon: A large number of patients were evaluated because we are a reference hospital. The most common culprit drug group in POH is NMBA; reanesthesia situations are safe after allergist evaluation.