From the Guidelines
Flushed cheeks after anesthesia are typically caused by vasodilation, a widening of blood vessels that increases blood flow to the face, often triggered by medications such as opioids, inhalational anesthetics, and propofol. This reaction is commonly seen due to the use of medications during anesthesia, particularly opioids like fentanyl and morphine, which can trigger histamine release 1. Inhalational anesthetics such as sevoflurane and desflurane also cause peripheral vasodilation as a side effect. Additionally, some patients experience this reaction from propofol, a common induction agent.
The causes of anaphylaxis or anaphylactoid reactions related to anesthesia are listed in order of approximate frequency of occurrence, with muscle relaxants, latex, antibiotics, induction agents, opioids, and colloids being among the most common causes 1. However, the most recent and highest quality study suggests that careful review of prior anesthetic records and identification/avoidance of known triggers of mast cell activation are critical in preventing anaphylaxis in the perioperative period 1.
Some patients may experience more pronounced flushing due to their predisposition to vascular reactivity, such as those with rosacea or other skin conditions. The flushing is usually temporary and resolves as the medications are metabolized and eliminated from the body, typically within a few hours after surgery. For most patients, no treatment is necessary as this is a benign side effect. However, if the flushing is accompanied by difficulty breathing, hives, or significant drops in blood pressure, it could indicate an allergic reaction requiring immediate medical attention.
Key considerations for management include:
- Careful review of prior anesthetic records and identification/avoidance of known triggers of mast cell activation
- Pre-anesthetic treatment with anxiolytic agents, antihistamines, and possibly corticosteroids to reduce the frequency and/or severity of mast cell activation events
- Use of certain perioperative drugs considered safer, such as propofol, sevoflurane, or isoflurane, and avoidance of agents like muscle relaxants atracurium and mivacurium
- Management of mast cell activation symptoms depends upon their severity, and relies upon discontinuation of the suspected drug or anesthetic agent, fluid resuscitation, and intravenous epinephrine for severe reactions 1.
From the Research
Causes of Flushed Cheeks after Anesthesia
- Flushed cheeks after anesthesia can be caused by several factors, including the release of histamine, which is associated with anaesthetic agents such as thiopental and muscle relaxants 2.
- The incidence of flushing on induction of anaesthesia is more common in individuals who blush easily, with 32% of women and 22% of men who blush easily experiencing flushing after induction of anaesthesia 2.
- General anesthetics can also cause changes in vascular tone, leading to peripheral vasodilation and decreased vascular resistance, which may contribute to flushed cheeks 3.
- However, there is no direct evidence to suggest that flushed cheeks after anesthesia are caused by allergic reactions or anaphylaxis, although these conditions can cause similar symptoms 4.
- The use of multimodal general anesthesia, which involves the administration of different drugs together to create the anesthetic state, may also play a role in the development of flushed cheeks after anesthesia 5, 6.