Ekaterina Khaleva1,2,3, Amber Franz4, Lene Heise Garvey5, Nicola Jay6, Alyssa Ylescupidez7, Henry T Bahnson7, George du Toit1,8. 1. Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK. 2. Faculty of Medicine, MSc Allergy, University of Southampton, Southampton, UK. 3. inVIVO Planetary Health, Group of the Worldwide Universities, West New York, NJ, USA. 4. Seattle Children's Hospital, Seattle, WA, USA. 5. Danish Anaesthesia Allergy Centre, Allergy Clinic Gentofte Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 6. Sheffield Children's NHS Foundation Trust, Sheffield, UK. 7. Benaroya Research Institute and The Immune Tolerance Network, Seattle, WA, USA. 8. Department of Paediatric Allergy, King's Health Partners, King's College London, London, UK.
Abstract
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.
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.
Authors: Maria Anita Costa Spindola; Dirceu Solé; Marcelo Vivolo Aun; Liana Maria Tôrres de Araújo Azi; Luiz Antonio Guerra Bernd; Daniela Bianchi Garcia; Albertina Varandas Capelo; Débora de Oliveira Cumino; Alex Eustáquio Lacerda; Luciana Cavalcanti Lima; Edelton Flávio Morato; Rogean Rodrigues Nunes; Norma de Paula Motta Rubini; Jane da Silva; Maria Ângela Tardelli; Alexandra Sayuri Watanabe; Erick Freitas Curi; Flávio Sano Journal: Braz J Anesthesiol Date: 2020-09-17