Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia

Authors: Kroigaard¹; Garvey¹; Gillberg²; Johansson³; Mosbech⁴; Florvaag⁵; Harboe⁶; Eriksson⁷; Dahlgren⁷; Seeman-Lodding⁸; Takala⁹; Wattwil¹⁰; Hirlekar¹¹; Dahlén¹²; Guttormsen

Source: Acta Anaesthesiologica Scandinavica, Volume 51, Number 6, July 2007 , pp. 655-670(16)

Publisher: Blackwell Publishing

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Abstract:

The present approach to the diagnosis, management and follow-up of anaphylaxis during anaesthesia varies in the Scandinavian countries. The main purpose of these Scandinavian Clinical Practice Guidelines is to increase the awareness about anaphylaxis during anaesthesia amongst anaesthesiologists. It is hoped that increased focus on the subject will lead to prompt diagnosis, rapid and correct treatment, and standardised management of patients with anaphylactic reactions during anaesthesia across Scandinavia.

The recommendations are based on the best available evidence in the literature, which, owing to the rare and unforeseeable nature of anaphylaxis, mainly includes case series and expert opinion (grade of evidence IV and V).

These guidelines include an overview of the epidemiology of anaphylactic reactions during anaesthesia. A treatment algorithm is suggested, with emphasis on the incremental titration of adrenaline (epinephrine) and fluid therapy as first-line treatment.

Recommendations for primary and secondary follow-up are given, bearing in mind that there are variations in geography and resources in the different countries. A list of National Centres from which anaesthesiologists can seek advice concerning follow-up procedures is provided. In addition, an algorithm is included with advice on how to manage patients with previous suspected anaphylaxis during anaesthesia. Lastly, Appendix 2 provides an overview of the incidence, mechanisms and possibilities for follow-up for some common drug groups.

Keywords: Allergy; anaesthesia; anaphylaxis; drug allergy; investigation; treatment

Document Type: Research article

DOI: 10.1111/j.1399-6576.2007.01313.x

Affiliations: 1: Danish Anaesthesia Allergy Centre, Department of Anaesthesia, Section 4231 Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark 2: Department of Anaesthesia and Intensive Care, Central Hospital, SE-291 85 Kristianstad, Sweden 3: Department of Clinical Immunology, Karolinska University Hospital, L2:04 S-171 76 Stockholm, Sweden 4: Allergy Unit 4222, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark 5: Laboratory of Clinical Biochemistry, Section for Clinical Allergology, Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway 6: Department of Anaesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway 7: Department of Anaesthesiology and Intensive Care Medicine, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden 8: Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden 9: Department of Anaesthesiology and Intensive Care, Turku University Hospital, PO Box 52, 20521 Turku, Finland 10: Department of Anaesthesia and Intensive Care, Örebro University Hospital, SE-701 85 Örebro, Sweden 11: Department of Anaesthesia and Intensive Care, University Hospital FSA, Akureyri 600, Iceland 12: Department of Internal Medicine Huddinge, M54 Division of Respiratory Medicine and Allergology, Karolinska Institutet, SE-141 86 Stockholm, Sweden

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