Anesthesia Allergies: Risks and Alternatives for Patients

Q: Anesthesia Allergies: Risks and Alternatives for Patients

Hello, thank you for your question. <br>Here are my responses： <br>1. <br>If I developed acute pulmonary edema after surgery, is it likely due to an allergy to anesthesia, or could there be other possibilities? --> The likelihood is very low. <br>It may be necessary to confirm wh

Anesthesia Allergy Consultation

About three years ago, I had to undergo surgery for testicular torsion.
At that time, I received general anesthesia administered through an IV.
I’m not sure if it was during or after the surgery, but the doctor mentioned that I developed pulmonary edema due to an allergic reaction to the anesthetic, which led to my admission to the intensive care unit.
Recently, I need to undergo a colonoscopy at Cathay General Hospital, and I informed the doctor about my previous anesthetic allergy.
After asking for details, the doctor stated that intravenous anesthesia typically does not cause pulmonary edema and mentioned that there are always risks associated with anesthesia.
However, my concerns remain unresolved.
I would like to inquire whether my acute pulmonary edema following surgery was indeed caused by an allergic reaction to the anesthetic, or if there could be other possibilities.
If it was an allergic reaction, are there alternative anesthetics that could be used? Additionally, is there a specific genetic test that can identify this type of allergy? Thank you for your assistance.

En, 20~29 year old female. Ask Date: 2023/12/11

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
If I developed acute pulmonary edema after surgery, is it likely due to an allergy to anesthesia, or could there be other possibilities? --> The likelihood is very low.
It may be necessary to confirm whether it was indeed pulmonary edema or another cause, such as acute respiratory distress syndrome, and whether there is suspicion that the anesthetic agent was the most likely contributing factor to the event.
2.
If it is indeed an allergy to anesthesia, are there alternative anesthetics available? --> Currently, there are multiple anesthetic agents used in outpatient procedures, so if you are very concerned, it is advisable to discuss this with an anesthesiologist.
3.
Is it possible to conduct genetic testing to determine this type of allergy? --> Currently, the availability of genetic testing to predict drug allergies is quite limited.
To my knowledge, preventive pharmacogenetic testing does not yet include anesthetic agents.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2023/12/11

More Info

Understanding anesthesia allergies and their implications is crucial for patients who have experienced adverse reactions in the past. Your concern regarding a previous incident of pulmonary edema following anesthesia is valid, and it’s important to explore the potential causes and alternatives for future procedures.

Anesthesia Allergies and Reactions
Anesthesia can indeed provoke allergic reactions, although they are relatively rare. The symptoms of an allergic reaction can range from mild (such as rash or itching) to severe (such as anaphylaxis). In your case, the development of pulmonary edema could be attributed to several factors, not solely an allergic reaction to the anesthetic agent.
Pulmonary edema can occur due to fluid overload, heart failure, or even as a complication of the surgical procedure itself. It is essential to differentiate whether the edema was a direct result of an allergic reaction to the anesthetic or if it was due to other underlying health issues or surgical complications.

Potential Causes of Pulmonary Edema
1. Fluid Management: During surgery, fluids are administered intravenously. If too much fluid is given, it can lead to fluid accumulation in the lungs.

2. Cardiovascular Issues: Pre-existing heart conditions can increase the risk of pulmonary edema, especially under the stress of surgery and anesthesia.

3. Anesthetic Agents: While rare, certain anesthetic agents can cause respiratory complications. However, the specific agent used during your previous surgery would need to be identified to assess its potential link to your reaction.

Alternatives to Traditional Anesthesia
If you have a documented allergy to a specific anesthetic agent, it is crucial to inform your anesthesiologist before any procedure. They can then consider alternative anesthetic techniques or agents. For instance:
- Regional Anesthesia: Techniques such as spinal or epidural anesthesia may be used, depending on the procedure.

- Different Anesthetic Agents: If you are allergic to one class of anesthetics (e.g., barbiturates), there are other classes (e.g., propofol, etomidate) that might be safer for you.

Genetic Testing for Anesthesia Allergies
Currently, there is no standard genetic test specifically for anesthesia allergies. However, some institutions may conduct tests for specific drug allergies, particularly if there is a strong family history of reactions. Discussing your concerns with an allergist or a specialist in pharmacogenetics may provide insights into whether genetic testing could be beneficial in your case.

Consultation with Anesthesia Specialists
Given your history, it is essential to have a thorough pre-anesthesia consultation. This should include:
- A detailed review of your medical history, including your previous reaction.

- A discussion of the specific anesthetic agents that will be used for your upcoming procedure.

- An assessment of your overall health, including any cardiovascular or respiratory issues that may increase your risk during anesthesia.

Conclusion
In summary, while your previous experience with pulmonary edema raises valid concerns, it is essential to approach this with a comprehensive understanding of the potential causes and alternatives. Open communication with your healthcare providers, especially your anesthesiologist, is key to ensuring your safety during future procedures. They can tailor an anesthetic plan that minimizes risks based on your medical history and specific needs. Always advocate for your health and ensure that all your concerns are addressed before undergoing any medical procedure.

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