Review explores diagnosis and management of perioperative anaphylaxis during anesthesia

Perioperative anaphylaxis is a rare, life‐threatening condition during anesthesia. The unique setting – multiple drugs, patient draping, and altered physiology – causes higher mortality than anaphylaxis elsewhere. This review covers evolving etiology, pathophysiology, atypical presentation, evidence‐based management, and prevention. Primary triggers include neuromuscular blocking agents, antibiotics, and latex, with emerging culprits (chlorhexidine, dyes, remimazolam). Diagnosis is challenging due to few cutaneous signs; cardiovascular collapse with low end‐tidal CO2 is a key supportive indicator. Immediate management prioritizes epinephrine and aggressive fluids. Post‐event allergological testing (skin tests, tryptase/histamine) identifies the culprit. Prevention includes history‐taking, risk stratification, and latex‐free environments. Future directions: global surveillance, novel biomarkers (circulating microbiome), and simulation training.

Review explores diagnosis and management of perioperative anaphylaxis during anesthesia. Introduction Incidence 1:2,000–1:20,000 procedures, but mortality higher than community anaphylaxis. Diagnosis difficult due to anesthesia‐induced changes, lack of patient feedback, and multiple triggers. This narrative review synthesizes recent evidence (2017–2025). Pathophysiology and evolving etiology Primarily IgE‐mediated mast cell/basophil degranulation; non‐IgE reactions also occur. Mediators cause vasodilation, capillary leak, bronchoconstriction. Primary triggers : NMBAs (most common), β‐lactam antibiotics, latex (declining with avoidance). Emerging triggers : Chlorhexidine, patent blue dye, remimazolam (case reports; cross‐reactivity with midazolam inconclusive). High‐risk for latex : spina bifida, chronic bladder catheterization, healthcare...