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Perioperative anaphylaxis in children: Etiology, time sequence, and patterns of clinical reactivity

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  • Ekaterina Khaleva
  • Amber Franz
  • Lene Heise Garvey
  • Nicola Jay
  • Alyssa Ylescupidez
  • Henry T Bahnson
  • George du Toit
Vis graf over relationer

BACKGROUND: Perioperative anaphylaxis (PA) in children is an uncommon but potentially life-threatening complication associated with anesthesia. Early identification and management of PA is essential to optimize clinical outcomes.

METHODS: We performed a retrospective study of anesthesia records from pediatric patients with PA from centers in the United Kingdom, France, and the United States over a period of 10 years. Time sequence of clinical signs and physiological variables during PA were collected, along with results of allergy testing.

RESULTS: Twenty-nine children with PA were included. Median age was 11 years. Based on the modified Ring and Messmer Grading Scale, severe reactions were seen in 25 (86%) members of this cohort, with 4 (14%) experiencing cardiac arrest. Life-threatening hypotension was the first clinical sign of PA in 59% of cases, followed by tachycardia and bronchospasm. In 16 (55%) cases, the initial signs of PA involved multiple organ systems. When the initial signs of PA were cardiovascular and/or respiratory, more epinephrine doses were administered. Average time from initial sign of PA to treatment with epinephrine was 6 minutes (SD: 6, range: 1-25). The causative allergen was identified in 15 patients.

CONCLUSION: Severe hypotension is the most common presenting sign of PA in children. Initial cardiovascular and/or respiratory signs are associated with the need for increased epinephrine doses. Further studies should optimize the prediction, identification, and early management of PA in children.

OriginalsprogEngelsk
TidsskriftPediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology
Vol/bind31
Udgave nummer1
Sider (fra-til)85-94
Antal sider10
ISSN0905-6157
DOI
StatusUdgivet - jan. 2020

Bibliografisk note

© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

ID: 59017287