Diagnosis of the causes of anaphylactoid anaesthetic reactions

Adverse, anaphylactoid, reactions to the intravenous drugs and other substances used in anaesthesia and surgery pose a major problem in many countries. The scope of the problem is somewhat difficult to judge since agreement can rarely be reached as to what is, or as to what is not, an adverse reaction. While the death of a fit young patient undergoing minor investigative surgery is an obvious candidate for inclusion, many of the very minor incidents of urticaria, mild hypotension and mild bronchospasm are less easy to classify since they may arise from theatre techniques, from underlying pathology, known or unsuspected, as well as from complex psychosomatic and psychosocial stimuli. Minor manifestations may not hinder the immediate procedure, but their incorrect interpretation may lead to a disaster during a general anaesthetic procedure weeks, or even years, later.