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notesanaphylaxis

Anaphylaxis


Anaphylaxis

  • A life threatening allergic reaction
  • Antigen binds to IgE antibodies on mast cells and basophils, causing release of histamine, leukotrienes, kinin, platelet-activating factor, and others
  • Occurs in 1 in 10,000 anesthetics
  • Most common cause is succinylcholine
  • Anaphylactoid reaction is similar but there is no IgE involved
  • The risk of immediate hypersensitivity reaction during anesthesia is estimated to be between 1 in 10,000 and 1 in 20,000 anesthetics. Neuromuscular blocking drugs are the most common agents associated with this event (60%) with succinylcholine being the most frequent. The mortality related to anaphylaxis is from 5 to 10%.
  • Tryptase is a marker of mast cell activation in anaphylaxis. In cases of unexpected arrest or death at induction of general anesthesia, blood tryptase and IgE measurements may help identify anaphylaxis.
  • Treatment
    • Discontinue anethetics
    • Give 100% oxygen
    • Volume expansion
    • Epinephrine 50-100 mcg IV, or 0.5 mg IV for cardiac collapse
    • Hydrocortisone 250-500 mg
    • Diphenhydramine 25-50 mg
    • Aminophylline 6 mg/kg for bronchospasm
    • CPR if needed

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