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Review
. 2025 Apr;72(4):649-674.
doi: 10.1007/s12630-025-02915-5. Epub 2025 Apr 17.

Perioperative anaphylaxis: an update on pathophysiology, diagnosis, and management

Martin Ma  1   2 , Dallas Duncan  1   2 , Justyna Bartoszko  3   4   5   6
Affiliations
Review

Perioperative anaphylaxis: an update on pathophysiology, diagnosis, and management

Martin Ma et al. Can J Anaesth. 2025 Apr.

Abstract
in English, French

Purpose: In this Continuing Professional Development module, we provide a framework for the prompt diagnosis and management of perioperative anaphylaxis.

Principal findings: Anaphylaxis in the perioperative period can lead to sudden cardiorespiratory compromise. Hypotension, tachycardia, and bronchospasm are the most common presenting signs of anaphylaxis; however, they are nonspecific, making diagnosis challenging. Associated factors that support a diagnosis of anaphylaxis include the timing of symptom onset, a lack of response to first-line vasopressors, evidence of severe hypovolemia, and the appearance of a rash. Treatment should not be delayed in the absence of cutaneous findings, as hemodynamic compromise is often the main presenting feature. Appropriate treatment involves administering epinephrine, resuscitating with fluids, protecting the airway, and removing any triggering agents.

Conclusions: Anaphylaxis is a challenge to diagnose and clinically manage in the perioperative period. Provider vigilance, a high index of suspicion, and timely treatment are necessary to ensure the successful resuscitation and safety of the patient.

RéSUMé: OBJECTIF: Dans ce module de développement professionnel continu, nous proposons un cadre pour le diagnostic et la prise en charge rapides de l’anaphylaxie périopératoire. CONSTATATIONS PRINCIPALES: L’anaphylaxie en période périopératoire peut entraîner une atteinte cardiorespiratoire soudaine. L’hypotension, la tachycardie et le bronchospasme sont les signes les plus courants d’anaphylaxie; ils ne sont toutefois pas spécifiques, rendant le diagnostic difficile. Les facteurs associés à l’appui d’un diagnostic d’anaphylaxie comprennent le moment d’apparition des symptômes, l’absence de réponse aux vasopresseurs de première intention, des signes concrets d’hypovolémie sévère, et l’apparition d’une éruption cutanée. Le traitement ne doit pas être retardé en l’absence de signes cutanés car l’atteinte hémodynamique est souvent le principal signe de présentation. Le traitement approprié comporte l’administration d’épinéphrine, la réanimation liquidienne, la protection des voies aériennes et l’élimination de tout agent déclencheur. CONCLUSION: L’anaphylaxie est un défi à diagnostiquer et à gérer cliniquement au cours de la période périopératoire. La vigilance des prestataires, un indice de suspicion élevé et un traitement rapide sont nécessaires pour assurer une réanimation réussie et la sécurité des patients et patientes.

Keywords: allergy; anaphylaxis; perioperative; review.

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References

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