Peri-Anaesthetic Anaphylaxis; Comparisons Between Cardiovascular and Skin Manifestations in Children and Adults.

Anaphylaxis during anaesthesia is rare and sometimes difficult to diagnose; relatively little is known about the time-sequence of cardiovascular and mucocutaneous manifestations of anaphylaxis and if children and adults are different. Retrospective study of peri-anaesthetic anaphylaxis events during 2008-2014. The time sequence of skin and cardiovascular symptoms were documented from anaesthetic charts. Fifty-three patients with confirmed peri-anaesthetic anaphylaxis were included, 14 children (6yo average age) and 39 adults (52yo average age). In children the lowest recorded systolic blood pressure (BP) was 35 mm Hg (mean 53.1) and diastolic BP 15 mm Hg (mean 26.64), while in adults 30 mm Hg (mean 52.78) and 12 mm Hg (mean 30.08) respectively. The mean time of documented hypotension after induction of anaesthesia was 8.7 min (SD ±9.5) in children and 27.47 min (SD ±14.33) in adults and after administration of the causative drug was 4.67 min (SD ±6.43) in children and 11.45 min (SD ±17.33) in adults. Out of the 53 cases, 26 (49%) were accompanied by tachycardia, and in 4 adults-hypotension preceded tachycardia (mean time 5 min). Thirty-nine (73%) patients had skin symptoms, mostly manifested as urticaria and flushing (mean time to develop post causative drug was 6 min (range 0-45)). There were no time differences in children and adults, but skin symptoms developed soon after exposure to neuromuscular blocking drugs (mean 2,3min) in both groups. Anaphylaxis and tachycardia can develop rapidly after induction and may develop sooner in children as compared to adults. Skin symptoms are frequently associated with peri-anaesthetic anaphylaxis.