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G Liccardi,1 G Lobefalo,1
E Di Florio,2 C Di Iorio,3 L
Occhiochiuso,4 L Romano,5 G Savoia,6
RM Massa,7 and G DAmato1 on
behalf of the Cardarelli Hospital Radiocontrast Media
and Anesthetic-Induced Anaphylaxis Prevention (CHRAIAP)
Working Group |
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1Department of Chest Diseases,
Division of Pneumology and Allergology, A Cardarelli
High Specialty Hospital, Naples, Italy
2Department of Gastroenterology and Liver
Transplantation, Service of Anesthesiology and
Postoperative Care, A Cardarelli High Specialty
Hospital, Naples,
3Department of General and Specialist Surgery, Service
of Anesthesiology and Postoperative Care, A Cardarelli
High Specialty Hospital, Naples, Italy
4Department of Medical and Surgical Emergency, Service
of Anesthesiology and Postoperative Care, A Cardarelli
High Specialty Hospital, Naples, Italy
5Department of Diagnostic Imaging, Unit of General and
Emergency Radiology, A Cardarelli High Specialty
Hospital, Naples, Italy
6Department of Maternal and Childhood Diseases, Service
of Anesthesiology, A Cardarelli High Specialty Hospital,
Naples, Italy
7Internal Unit of Statistics, A Cardarelli High
Specialty Hospital, Naples, Italy |
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Abstract |
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General anesthetics
and contrast media
can cause
anaphylactic as well
as anaphylactoid
reactions. These
events are of great
concern to
radiologists and
anesthesiologists
because of their
relatively high
prevalence, possible
threat to life, and
medical-legal
consequences.
Points discussed in
this review are the
critical evaluation
of risk factors
affecting prevention
strategies, the need
to be aware of
pathogenic
mechanisms relevant
to prevention
strategies, the use
of alternative
products if a
culprit agent is
known, the
recognition of early
signs of a reaction,
the need to keep
records of reactions
on a patients
medical chart, the
planning of
prophylactic therapy,
recommended actions
after a reaction to
an anesthetic or
contrast medium, and
the suggested
establishment of
allergy-anesthesiology
centers to improve
cooperation, and
medical-legal issues.
As any drug or
contrast medium
administered during
general anesthesia
or a diagnostic
procedure can induce
a potentially life-threatening
or fatal event even
in the absence of
any evident risk
factor in the
patients medical
history or clinical
status, we usually
premedicate
susceptible
individuals at least
to attenuate the
severity of an
unpredictable
reaction, although
we cannot rely on
the effi cacy of
premedication to
completely prevent a
severe event. These
recommendations,
which are based on
the literature and
on the experience of
our working group,
aim to provide
useful information
for physicians and
other specialists
who operate in the
absence of an
allergy consultant.
Key words:
Allergy. Anaphylaxis.
Anesthesia.
Bronchial asthma.
Histamine.
Hypersensitivity.
Contrast media.
Premedication.
Prophylaxis.
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