Generally occurs immediately after drug injection (2-15 mins).
Generally occurs immediately after drug injection (2-15 mins).
Generally related to iv agents.
Rarely occurs 2.5 hour after the drug therapy.
No death reports > 6 hours after the reaction.
Reaction time following oral drug intake is unpredictable ?
STOP the responsible agent
STOP the responsible agent
Call for HELP
Warn the SURGEON
Trandelenburg position
Ventilation+%100 O2
Fluid therapy:
500-1000 mL iv adult, ≥20 mL/kg çocuk
(%09 NaCl, RL)
ADULT:
ADULT:
Severe anaphylaxis
0.1-1 mg iv
0.5-0.8 mg im
Mild rxn: 10-50 micg iv
CORTICOSTEROID
CORTICOSTEROID
Adult
HIDROCORTISON 250 mg,
M.Prednisolon 80 mg iv
Pediatric
HIDROCORTISON 50-100 mg,
M.Prednisolon 2 mg/kg iv
NORADRENALIN: 0.05-0.1 mcg/kg/min
VASOPRESSIN : 2-10 IU iv doses until response.
GLUCAGON : 1-2 mg iv doses until response (in patients taking beta-blocker & unresponsive to high dose adrenaline).
Polen, animal fur, dust atopy
Polen, animal fur, dust atopy
Former prolonged latex exposure
may develop reaction with LATEX.
Anaphylaxis with Local Anesthetics is RARE; prefer Regional or local anesthesia.
Anaphylaxis with Local Anesthetics is RARE; prefer Regional or local anesthesia.
Agent of choice for General anesthesia is VOLATILE. “No Anaphylaxis is reported”
AVOID Latex & Neuromusculer blockers !
Antihistaminic/steroid premedication does not prevent “anaphylactic shock” ?
If known to cause a previous reaction, avoid using that drug/agent.
After a moderate-severe anaphylactic rxn:
After a moderate-severe anaphylactic rxn:
Follow-up with blood (triptase), then skin test.
Skin test: skin prick, intradermal test (IgE) or
If there is a local or disseminated urticeria related to Chlorhexidin skin test is necessary.
Follow-up is not necessary:
Erhythema around the injection site, isolated bronchospasm in patients with previous bronchial reactivity.
Symptoms
Symptoms
Severity of the reaction
Onset time and length of the reaction,
Therapy
All the agents used before the reaction
Anesthesia form, notes
Fill the advers event form.
Serum triptase & IgE Ab.
Serum triptase & IgE Ab.
Blood sample for analysis must be drawn within 1-4 hrs following the rxn. 5-10 mL blood, serum. The timing of the blood sampling after the reaction should be noted ?
Control blood sample should be drawn before Anaphylaxis or 24 hrs after the reaction.
Blood for IgE analysis can be sampled within 6 months after the reaction.
Skin test:
Skin test:
Evaluates mast cell rxn by IgE. Salin (-) control, Histamin (+) control. Test has to be done 6 weeks after the reaction.
Bir NMBA ile (+) sonuç alındıysa, diğer NMB test edilmeli.
Bir LA rxn varsa diğerleri test edilmeli. Cross reactivity.
Drug provacation test: RISKY !
It has to be performed after the skin test.
Generally 1/10 of the therapeutic dose of the drug responsible for the reaction is given via same route.
NMBA. (skin prick test “gold standart”)
NMBA. (skin prick test “gold standart”)
1/5.000-10.000 (france,norway,GB).
Other countries 1/50.000-1/150.000.
Latex (<5-17.7%)
Antibiotics. (Penicillin 0.1%)
15% of all the Anaphylactic rxns
Chlorhexidin.
12% of all the rxns during anesthesia are related to it (in denmark).
Gelatin (4%-france). HES (0.006%)
Ketamine, Midazolam. Very rare.
Opioids. Low incidance.
L.Anesthetics. Very low.
Propofol. (2.3%) Rare.
Thiopental. 1/23.000-29.000
(higher in female)
NSAID. (general population 1%) rarely a problem during anesthesia. COX-2 inhibitors may be safer ?
