An Analysis of Perioperative Anesthetic Adverse Events in
Thailand [PAAd Thai]: Allergic Reaction/Anaphylactoid/
Anaphylaxis
Aksorn Pulnitiporn MD1, Ratchayakorn Limapichat MD1, Anantachote Vimuktanandana MD2,
Thanist Pravitharangul MD3, Worawut Lapisatepun MD4, Nopadon Chernsirikasem MD5, Wimonrat Sriraj MD6,
Sunthiti Morakul MD3, Thidarat Ariyanuchitkul MD7
Affiliation :
1 Department of Anesthesiology, Khon Kaen Hospital, Khon Kaen, Thailand
2 Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
3 Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
4 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
5 Department of Anesthesiology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
6 Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
7 Department of Anesthesiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Background : Perioperative anaphylaxis or anaphylactoid reaction is an uncommon event and dif(cid:976)icult to diagnose. Clinical symptoms
range from mild with skin lesion to serious life-threatening conditions.
Objective : To describe characteristics of patients who developed anaphylaxis or anaphylactoid reaction during anesthesia including
signs, symptoms, treatment, outcome, and suggestive strategies for perioperative anaphylaxis or anaphylactoid reaction in Thailand.
Materials and Methods : A prospective descriptive study was conducted by using data from (cid:976)irst 2,000 incident reports of the
Perioperative and Anesthetic Adverse Events in Thailand [PAAd Thai] study. Patient characteristic and detail of anaphylaxis including
signs, symptoms, probable causes, treatment, and immediate outcome were recorded. All data were reviewed by three experienced
anesthesiologists. Descriptive statistics was used.
Results : After reviewed, 70 incidents were identi(cid:976)ied as perioperative anaphylaxis or anaphylactoid reaction. Anaphylaxis occurred
more commonly in female. Most (98.5%) were ASA I-III with mean age 42.6±2.5 years. Seventy-two-point-nine percent of events
occurred during general anesthesia. By using clinical severity, patients were classi(cid:976)ied as grade I, II, III, in 38, 4, and 28 patients,
respectively. Suspected causes were identi(cid:976)ied in 41 cases. The most common causes were antibiotic, blood component, and colloid,
in 13, 9, and 6 cases, respectively. Clinical manifestations of grade III were hypotension, rash or urticarial, bronchospasm, tachycardia,
and angioedema, in 21, 18, 15, 11, and 5 patients, respectively. Only 19 from 28 patients in grade III received adrenaline treatment.
All patients in grade I and II recovered completely. In grade III, surgery was postponed in (cid:976)ive cases and two cases were admitted
to ICU. Only one patient received serologic test and skin test.
Conclusion : To improve outcome, guidelines for perioperative anaphylaxis management should be followed. After anaphylaxis
event, proper investigation to identify de(cid:976)inite cause should be done at proper time.
Keywords : Anaphylaxis, Anaphylactoid reactions, Allergic reactions, Perioperative, Adverse event, Drug allergy
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