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Rajan S, Mathew J, Tosh P, et al. Safety of Inhalational Anesthesia in Patients with Multiple Drug Allergies Presenting for Major Surgeries under General Anesthesia. Anesth Essays Res. 2019;13(2):259-263doi: 10.4103/aer.AER_28_19.
Rajan, S., Mathew, J., Tosh, P., & Sudevan, M. (2019). Safety of Inhalational Anesthesia in Patients with Multiple Drug Allergies Presenting for Major Surgeries under General Anesthesia. Anesthesia, essays and researches, 13(2), 259-263. https://doi.org/10.4103/aer.AER_28_19
Rajan, Sunil, et al. "Safety of Inhalational Anesthesia in Patients with Multiple Drug Allergies Presenting for Major Surgeries under General Anesthesia." Anesthesia, essays and researches vol. 13,2 (2019): 259-263. doi: https://doi.org/10.4103/aer.AER_28_19
Rajan S, Mathew J, Tosh P, Sudevan M. Safety of Inhalational Anesthesia in Patients with Multiple Drug Allergies Presenting for Major Surgeries under General Anesthesia. Anesth Essays Res. 2019 Apr-Jun;13(2):259-263. doi: 10.4103/aer.AER_28_19. PMID: 31198241; PMCID: PMC6545938.
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Anesth Essays Res. 2019 Apr-Jun;13(2):259-263. doi: 10.4103/aer.AER_28_19.

Safety of Inhalational Anesthesia in Patients with Multiple Drug Allergies Presenting for Major Surgeries under General Anesthesia.

Anesthesia, essays and researches

Sunil Rajan, Jacob Mathew, Pulak Tosh, Manu Sudevan

Affiliations

  1. Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

PMID: 31198241 PMCID: PMC6545938 DOI: 10.4103/aer.AER_28_19

Abstract

The prevalence of perioperative anaphylaxis is 1 in 1250-20,000 anesthetics. Inhalational anesthesia is considered safe in patients with multiple drug allergies, as there have been no reports of anaphylaxis to volatile inhalational agents. Anesthetic management of six patients with documented allergy to all commonly used anesthetic drugs who underwent major surgeries under general anesthesia is described as a case series. The plan of anesthesia in these patients was an anesthetic gas-based general anesthesia without using muscle relaxants but with the use of intravenous fentanyl if patient was not allergic to it. Sevoflurane 8% in oxygen was used for induction. Following cessation of breathing and on attaining an end-tidal concentration of >4% sevoflurane, direct laryngoscopy and intubation were performed. Anesthesia was maintained with sevoflurane in nitrous oxide and oxygen mixture maintaining a lower end-tidal carbon dioxide. Hypotension and/or bradycardia were managed with intermittent intravenous boluses of adrenaline 20 μg. At the end of surgery, all anesthetic gases were cutoff, and patients were extubated when awake. No muscle relaxant was used in any of the cases. Two patients received fentanyl before induction, whereas others were given oral paracetamol 2 h before induction. Postoperative analgesia was provided with oral paracetamol which was given 2-4 h after surgery. Intraoperative period was uneventful for these patients. In patients with multiple drug allergies, inhalational agent-based general anesthesia can be considered as a safe alternative to regular anesthetic practice involving polypharmacy, with a reduced risk of perioperative adverse events.

Keywords: Anaphylaxis; drug allergy; general anesthesia; inhalational

Conflict of interest statement

There are no conflicts of interest.

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