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Suspected anaphylactic reactions associated with anaesthesia
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countries [13]. Reactions range from contact dermatitis to life-threatening
anaphylaxis. Anaphylaxis has occurred when chlorhexidine was used as an
antiseptic for urological and gynaecological procedures as well as insertion
of central venous and epidural catheters. The chlorhexidine coating of
certain central venous catheters has been implicated in such reactions. It is
prudent to allow skin disinfectant to completely dry before beginning an
invasive procedure. Anaphylaxis to polyvinylpyrrholidine as povidoneiodine
or as an excipient for oral medicines occurs but is rare.
Miscellaneous agents
Many agents to which patients may be exposed during anaesthesia may be
associated with anaphylaxis, including aprotinin, protamine, heparins,
radiological contrast material, dyes and oxytocin. Anaphylaxis to glycopyrronium
and neostigmine may occur very rarely.
References
1 Axon AD, Hunter JM. Editorial III: Anaphylaxis and anaesthesia – all clear now?
British Journal of Anaesthesia 2004; 93: 501–4.
2 Mertes PM, Laxenaire MC, Alla F. Anaphylactic anaphylactoid reactions
occurring during anaesthesia in France in 1999–2000. Anesthesiology 2003; 99:
536–45.
3 Fisher MM, Baldo BA. The incidence and clinical features of anaphylactic
reactions during anesthesia in Australia. Annales Francaises d’Anesthesie et de
Reanimation 1993; 12: 97–104.
4 Laxenaire MC. Epidemiology of anesthetic anaphylactoid reactions. Fourth
multicenter survey (July 1994-December 1996). Annales Francaises d’Anesthesie et
de Reanimation 1999; 18: 796–809.
5 Laxenaire MC, Mertes PM. Anaphylaxis during anaesthesia. Results of a
two-year survey in France. British Journal of Anaesthesia 2001; 87: 549–58.
6 Lang DM, Alpern MB, Visintainer PF, Smith ST. Increased risk for anaphylactoid
reaction from contrast media in patients on beta-adrenergic blockers or
with asthma. Annals of Internal Medicine 1991; 115: 270–6.
7 Laake JH, Rottingen JA. Rocuronium and anaphylaxis – a statistical challenge.
Acta Anaesthesiologica Scandinavica 2001; 45: 1196–203.
8 Florvaag E, Johansson SG, Oman H, et al. Prevalence of IgE antibodies to morphine.
Relation to the high and low incidences of NMBA anaphylaxis in Norway
and Sweden, respectively. Acta Anaesthesiologica Scandinavica 2005; 49: 437–44.
9 Porri F, Lemiere C, Birnbaum J, et al. Prevalence of muscle relaxant sensitivity
in a general population: implications for a preoperative screening. Clinical and
Experimental Allergy 1999; 29: 72–5.
Ó 2009 The Authors
Journal compilation Ó 2009 The Association of Anaesthetists of Great Britain and Ireland 11