الفهرس 
PATHOPHYSIOLOGYOnly 14 pages are availabe for public view
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Abstract
Background: Anaphylaxis is an immediate immunological mediated severe allergic reaction to an administered substance. That result in respiratory and/or cardiovascular compromise often associated with urticaria and/or angioedema, these symptoms result from the release of inflammatory mediators from mast cells and can be triggered by allergen interaction with specific IgE on the mast cell surface or can be non-IgE mediated (pseudoallergic or anaphylactoid reactions). In anaphylaxis, mast cell degranulation leads to markedly increased blood tryptase concentrations which can be useful for the investigation of suspected cases. Tryptase concentration in the blood may not increase significantly until 30 minutes or more after the onset of symptoms and peak 1-2 hours after onset, there are some reactions that cause similar symptoms, but are not due to production of IgE, it can be more difficult to identify the exact cause of these reactions. Aim of the Work: is to review the effects of anesthetic drugs that cause anaphylaxis in perioperative period and to give an idea about new modalities of management of anaphylaxis during anesthesia. Patients and Methods: Meta-analysis. Abstracts of articles identified using the search strategy above will be viewed, and articles that appear to fulfill the three groups inclusion criteria/ Exclusion criteria will be retrieved in full. Data on at least one of the outcome measures must be included in the study. Results: Meta-analysis study was done on worldwide patients using pub med and Med-s cape data. These patients were using certain drugs agents during anesthesia and developed perioperative anaphylaxis. These drugs were Propofol as a Hypnotics, Rocuronium as a muscle relaxant and Fentanyl as an opioid analgesic. The total number of cases were twenty eight. Fourteen were on Rocuronium, eleven were on Propofol and three were on Fentanyl. All the cases were matched according to age, sex, BMI as well as pre-operative morbidities in the form of HTN, DM, pulmonary hypertension, cerebral palsy, hemiplegia, masseter stiffness, tricusped regurge. There was also no significant past history of allergy to the different assessed drugs (Rocuronium, Propofol and Fentanyl). This study showed that perioperative anaphylaxis was significant with the Fentanyl group in comparison to the two other groups Rocuronium and Propofol. Conclusion: We conclude that there is no a drug used in anesthesia is free from anaphylactic reaction. Opioid analgesic that are considered safe according to literature is considered according to the current study the first one to cause anaphylaxis with the longest anaphylactic duration. Despite that it leads to a mild form of anaphylaxis which is self limiting. Neuromuscular blocking agents such as Rocuronium is the second to cause anaphylaxis but it manifest earlier and present with the most severe form which is hypotension. Propofol anesthetic is considered the safest drug but it isn’t completely safe. It leads occasionally to anaphylaxis.