Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow‐up of anaphylaxis during anaesthesia

• Published in: Acta anaesthesiologica Scandinavica Vol. 51; no. 6; pp. 655 - 670
• Main Authors: Kroigaard, M., Garvey, L. H., Gillberg, L., Johansson, S. G. O., Mosbech, H., Florvaag, E., Harboe, T., Eriksson, L. I., Dahlgren, G., Seeman‐Lodding, H., Takala, R., Wattwil, M., Hirlekar, G., Dahlén, B., Guttormsen, A. B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2007; Blackwell
• Subjects: Allergy; anaesthesia; Anaesthetics; Anaesthetics and intensive care; anaphylaxis; Anaphylaxis - classification; Anaphylaxis - diagnosis; Anaphylaxis - etiology; Anaphylaxis - therapy; Anestesiologi; Anestesiologi och intensivvård; Anesthesia; Anesthesia - adverse effects; Anesthesia - standards; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; drug allergy; Epinephrine - therapeutic use; Humans; Infusions, Intravenous; investigation; Kirurgi; Medical sciences; MEDICIN; MEDICINE; Oxygen Inhalation Therapy; Practice Guidelines as Topic; Resuscitation - standards; Scandinavian and Nordic Countries; Surgery; treatment; Scandinavian and Nordic Countries; Immunopathology; Allergy; Anaphylaxis; Clinical management; Treatment; drug allergy; Anesthesia; investigation; Diagnosis; anaesthesia
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/j.1399-6576.2007.01313.x

The present approach to the diagnosis, management and follow‐up of anaphylaxis during anaesthesia varies in the Scandinavian countries. The main purpose of these Scandinavian Clinical Practice Guidelines is to increase the awareness about anaphylaxis during anaesthesia amongst anaesthesiologists. It is hoped that increased focus on the subject will lead to prompt diagnosis, rapid and correct treatment, and standardised management of patients with anaphylactic reactions during anaesthesia across Scandinavia. The recommendations are based on the best available evidence in the literature, which, owing to the rare and unforeseeable nature of anaphylaxis, mainly includes case series and expert opinion (grade of evidence IV and V). These guidelines include an overview of the epidemiology of anaphylactic reactions during anaesthesia. A treatment algorithm is suggested, with emphasis on the incremental titration of adrenaline (epinephrine) and fluid therapy as first‐line treatment. Recommendations for primary and secondary follow‐up are given, bearing in mind that there are variations in geography and resources in the different countries. A list of National Centres from which anaesthesiologists can seek advice concerning follow‐up procedures is provided. In addition, an algorithm is included with advice on how to manage patients with previous suspected anaphylaxis during anaesthesia. Lastly, Appendix 2 provides an overview of the incidence, mechanisms and possibilities for follow‐up for some common drug groups.