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Diagnosis of perioperative anaphylaxis is difficult because of its non-specific and variable signs and symptoms. Therapeutic agents used to treat anaphylaxis and anaesthesiologist responses also vary depending on the case, which might affect outcomes; however, only a few studies have focused on these factors. This prospective study of perioperative anaphylaxis, a part of the Japanese Epidemiologic Study for Perioperative Anaphylaxis, investigated the clinical signs, its severity, therapeutic drugs, epinephrine administration, and anaesthesiologist responses in cases of perioperative anaphylaxis to assess trends and variability. Shock index was used to assess severity of cardiovascular collapse. In 43 patients analysed in this study, cardiovascular signs (88.4%) were the most frequent, followed by skin (81.4%) and respiratory signs (60.5%). The presence of signs increased during the clinical course. The median time from the first signs to diagnosis of anaphylaxis was 10 (5.0–17.8) min. The rates of epinephrine use were 30.2% (unused), 48.8% (i.v.), and 20.9% (i.m.). The median time from diagnosis of anaphylaxis to epinephrine administration was 7 (inter-quartile range: 1.5–8.0) min. Antihistamines and corticosteroids were each used in 69.8% of cases. The worst shock index was higher in patients who received i.v. epinephrine (2.77 [0.90] mean [standard deviation]) than in both no epinephrine use cases (1.35 [0.41]) and i.m. epinephrine cases (1.89 [0.77] (P <0.001]). The clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity. UMIN000035350. [ABSTRACT FROM AUTHOR]

Background: Tracheal extubation and emergence procedures induce abrupt changes in hemodynamics and humoral responses. The purpose of this study was to examine the effects of different doses of landiolol on hemodynamics during emergence from anesthesia., Methods: All patients undergoing general anesthesia were enrolled in this study. Immediately after the end of the surgery, all anesthetics were discontinued. Thereafter, during emergence from anesthesia, all patients were ventilated with 100% oxygen and landiolol infusion was started in all but the control group patients. In the normal dose group, landiolol infusion was started at a rate of 0.125 mg x kg(-1) x min(-1) for 1 min, decreasing it to 0.04 mg x kg(-1) x min(-1) until the time of extubation. In the low dose group, landiolol infusion was given at a rate of 0.06 mg x kg(-1) x min(-1) for 1 min and then continuously infused at the rate of 0.02 mg x kg(-1) x min(-1) until extubation., Results: Systolic and diastolic pressure increased during the emergence period in all 3 groups, there being no significant differences in systolic and diastolic pressure between the 3 groups during the observation period. Heart rate increased during the emergence period in the control group. In contrast, heart rate in both normal and low dose groups did not increase during the observation period., Conclusions: Landiolol could prevent the increase in heart rate but not blood pressure during emergence from anesthesia. Effects on the changes in heart rate between 0.125 and 0.06 landiolol groups were not significantly different.