The Thai Anesthesia Incident Monitoring Study of Perioperative Allergic Reactions: An Analysis of 1996 Incidents Reports
Worawut Lapisatepun MD*, Somrat Charuluxananan MD**, Chaiyapruk Kusumaphanyo MD***, Wichai Ittichaikulthol MD****, Sirilak Suksompong MD*****, Prapa Ratanachai MD******
Affiliation : * Department of Anesthesiology, Chiang Mai University, Chiang Mai ** Department of Anesthesiology, Chulalongkorn University, Bangkok *** Department of Anesthesiology, Srinakharinwirot University, Bangkok **** Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok ***** Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok ****** Department of Anesthesiology, Hatyai Regional Hospital, Songkla
Objectives: Analyze the clinical course, management, outcome, and contributing factors of perioperative
allergic reactions in the Thai Anesthesia Incident Monitoring Study (Thai AIMS).
Material and Method: A prospective descriptive multicenter study was conducted in 51 hospitals across
Thailand. Voluntary, anonymous reports of any adverse or undesirable events during the first 24 hours of
anesthesia were sent to the Thai AIMS data management unit. Possible perioperative allergic reactions were
extracted and examined independently by three peer reviewers.
Results : Forty-three reports of possible perioperative allergic reactions from the 2,537 incidents reported to
the Thai AIMS (1.6%) were reviewed. There was a female predominance (1.9:1). The most common features
were cutaneous manifestations (93%), arterial hypotension (20.1%), and bronchospasm (11.6%) respectively.
The severity grades were 69.8% in grade I, 4.7% in grade II, and 25.6% in grade III. The three most suspected
causative agents were neuromuscular blocking agents (39.5%, 30.2%-succinylcholine), antibiotics (27.9%),
and opioids (18.6%) respectively. All but one responded well to treatment with complete recovery. One patient
suffered acute myocardial infarction and had to stay at the hospital for longer than one week. None had
further allergic reaction.
Conclusion : Perioperative allergic reactions accounted for 1.6% of anesthetic adverse events. The most
common features were cutaneous manifestations. A quarter of these were life-threatening but responded well
to treatment. The most common suspected causative agent was succinylcholine.
Keywords : Allergic reactions, Anesthetics, Perioperaive, Multicenter study, Anaphylaxis, Anaphylactoid reaction
