The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: clinical signs, severity, and therapeutic agents
Diagnosis 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 thes...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2023-07, Vol.131 (1), p.170-177 |
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| creator | Sugiyama, Yuki Takazawa, Tomonori Watanabe, Natsuko Bito, Kiyoko Fujiyoshi, Tetsuhiro Hamaguchi, Shinsuke Haraguchi, Takashi Horiuchi, Tatsuo Kamiya, Yoshinori Maruyama, Noboru Masumo, Hitoshi Nakazawa, Harumasa Nagumo, Kazuhiro Orihara, Masaki Sato, Jun Sekimoto, Kenichi Takahashi, Kenichiro Uchiyama, Mutsumi Takahashi, Kazunobu Yamaguchi, Masao Kawamata, Mikito |
| description | Diagnosis 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.
This 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.
In 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 |
| doi_str_mv | 10.1016/j.bja.2023.02.023 |
| format | Article |
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This 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.
In 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]).
The clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity.
UMIN000035350.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1016/j.bja.2023.02.023</identifier><identifier>PMID: 36967279</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adrenal Cortex Hormones - therapeutic use ; anaphylaxis ; Anaphylaxis - diagnosis ; Anaphylaxis - drug therapy ; Anaphylaxis - epidemiology ; Anesthesia - adverse effects ; East Asian People ; epinephrine ; Epinephrine - therapeutic use ; Humans ; perioperative anaphylaxis ; Prospective Studies ; symptoms ; treatment</subject><ispartof>British journal of anaesthesia : BJA, 2023-07, Vol.131 (1), p.170-177</ispartof><rights>2023 The Author(s)</rights><rights>Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-e967e74d998a114eaab86d344222cd6e9600e36cd7707115e2e6b01cde1c66bd3</citedby><cites>FETCH-LOGICAL-c462t-e967e74d998a114eaab86d344222cd6e9600e36cd7707115e2e6b01cde1c66bd3</cites><orcidid>0000-0001-7954-4358 ; 0000-0002-0618-5988 ; 0000-0002-2508-3178 ; 0000-0002-6788-7633 ; 0000-0001-5872-4421 ; 0000-0002-0119-3532 ; 0000-0001-6023-582X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36967279$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sugiyama, Yuki</creatorcontrib><creatorcontrib>Takazawa, Tomonori</creatorcontrib><creatorcontrib>Watanabe, Natsuko</creatorcontrib><creatorcontrib>Bito, Kiyoko</creatorcontrib><creatorcontrib>Fujiyoshi, Tetsuhiro</creatorcontrib><creatorcontrib>Hamaguchi, Shinsuke</creatorcontrib><creatorcontrib>Haraguchi, Takashi</creatorcontrib><creatorcontrib>Horiuchi, Tatsuo</creatorcontrib><creatorcontrib>Kamiya, Yoshinori</creatorcontrib><creatorcontrib>Maruyama, Noboru</creatorcontrib><creatorcontrib>Masumo, Hitoshi</creatorcontrib><creatorcontrib>Nakazawa, Harumasa</creatorcontrib><creatorcontrib>Nagumo, Kazuhiro</creatorcontrib><creatorcontrib>Orihara, Masaki</creatorcontrib><creatorcontrib>Sato, Jun</creatorcontrib><creatorcontrib>Sekimoto, Kenichi</creatorcontrib><creatorcontrib>Takahashi, Kenichiro</creatorcontrib><creatorcontrib>Uchiyama, Mutsumi</creatorcontrib><creatorcontrib>Takahashi, Kazunobu</creatorcontrib><creatorcontrib>Yamaguchi, Masao</creatorcontrib><creatorcontrib>Kawamata, Mikito</creatorcontrib><title>The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: clinical signs, severity, and therapeutic agents</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Diagnosis 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.
This 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.
In 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]).
The clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity.
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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.
This 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.
In 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]).
The clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity.
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| subjects | Adrenal Cortex Hormones - therapeutic use anaphylaxis Anaphylaxis - diagnosis Anaphylaxis - drug therapy Anaphylaxis - epidemiology Anesthesia - adverse effects East Asian People epinephrine Epinephrine - therapeutic use Humans perioperative anaphylaxis Prospective Studies symptoms treatment |
| title | The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: clinical signs, severity, and therapeutic agents |
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