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Anes101 > Anaphylactic and Anaphylactoid Reactions During Anesthesia > Flashcards

Anaphylactic and Anaphylactoid Reactions During Anesthesia Flashcards

1
Q

Anaphylaxis

A

Reproducible adverse reaction to extrinsic substance mediated by immune system

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2
Q

Type 1 (acute)

A

Atopy, urticaria, angioedema, anaphylaxis

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3
Q

Type II (cytotoxic)

A

Hemolytic transfusion rx, HIT

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4
Q

Type III (immune complex)

A

Serum sickness

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5
Q

Type IV (delayed)

A

Contact dermatitis (red weepy skin, Pruriti) erythema, crack, and fissures, pruritis or pain

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6
Q

Anaphylaxis

A

a severe, life-threatening, generalized or systemic hypersensitivity reaction, primarily mediated by type E immunoglobulins.?

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7
Q

Anaphylaxis

A

Type 1, incidence 1:2,500-20,000, Mortality 6%, brain damage 2%

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8
Q

Anaphylaxis (clinical features)

A

rapid onset, prior exposure, ab-ag rxn, affects CV,Pulmonary, and cutaneous sys, circulatory collapse

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9
Q

Grade 1

A

Cutaneous mucus signs: erythema, urticaria, angiodema

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10
Q

Grade 2

A

Moderate multi-visceral: grade 1+/- HypoTN, tachycardia. Dyspnea, GI issues

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11
Q

Grade 3

A

Life threatening mono-multivisceral: CV collapse, tachy/bradycardia, +/- dyrrthmias, bronchospasm, cutaneous mucous, and GI disturbances

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12
Q

Grade 4

A

Cardiac arrest

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13
Q

Anaphylaxis

A

Patients sensitivity and route of admin determine severity. IV and mucous membrane exposure fastest and most sever rx

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14
Q

Anaphylaxis (risk factors)

A

Hx univestigated life threatening event, mastocytosis, allergy to an anesthesia drug, latex allergies inc risk, hx of atopy

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15
Q

Mechanism

A

Exposure to ag, production of spscfc IgE ab, ab fix to mast cell or basophils, reexposure bing to ab and cross linking, release of chemical mediators

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16
Q

productos of human mast cells

A

Granule proteins, cytokines, leukotrines, chemokines

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17
Q

Important mediators

A

Histamines, LK, PG

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18
Q

Histamines

A

Inc cap perm, Peripheral vasodilation, Bronchoconstriction

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19
Q

Leukotrienes (LK)

A

Bronchconstriction, inc cap perm, negative ionotropy

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20
Q

Prostaglandins (PG)

A

Bronchconstriction, vasodilations

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21
Q

Anaphylactoid

A

Non IgE anaphylaxis

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22
Q

Anaphylactoid (clinical)

A

Direct action on mast cells, MASSIVE release of histamine, may occur on 1st exposure, clinically indistinguishable, life thret, PREDISPOSITION: pregnancy,youth, atopy

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23
Q

Anaphylaxis (diagnosis)

A

Periop - challenging, multiorgan effects, pt cannot complain, anesthetic drugs mimic

24
Q

Anaphylaxis (diagnosis)

A

OR drapes, limited access delay Dx, variation in manifestations and course of rxn, spectrum of rxn from minor to CP collapse, lack of prior allergy hx

25
Q

Signs under anesthesia

A

Sudden and profound HypoTN, Circu collapse, bronchospasm, flush, edema, Cardiac arrest

26
Q

Circulatory collapse

A

profound vasodilation, HypoTN diff to tx, tachcardia, dysrrythmiasm Pulmonary vasoconstriction/HTN, cardiac arrest

27
Q

Kounis Syndrome

A

Acute Coronary event related to hypersensitivity rxn, may or not have predisposing factors to CAD, CA spasm/Angina, acute MI

28
Q

Pumonary Insults

A

wheezing, Bronchospasm difficult to tx, Increased PIP, Laryngeal edema/stridor, Acute pulmonary edema, acute respiratory failure/hypoxia

29
Q

Cutaneous signs

A

Urticaria, flushing, edema (periorbital and perioral)

30
Q

Differential DX

A

astma/ reactive airway, Cardiogenic shock, Tension pneumo, pericardial tamponade, pulmonary embolus, septic shock, vasovagal rxn, venous air embolism

31
Q

Tx goals

A

immediate recognition and tx

32
Q

Tx goals

A

stop ag admin, 100% O2 and PPv, stop volatile, IV volume expansion 1-4L, or 20mL/ kg boluses, Epi 100mcg, 0.1cc/kg IV, double and q3-5min, External cardiac massage

33
Q

Epi

A

inc cAMP, stabilizing cell membranes and inhibiting mediator release (increase ca++) b2 agonist effect (bronchodilation), alpha agonist effects (vasoconstriction)

34
Q

Anaphylatic shock refractory to catecholamines

A

due to desenstization of adrenergic receptors (beta blocker therapy), Inc dynthesis of NO contributes to HypoTN and resistance to pressors, NO and metabolic acidosis hyperpolarize K channels preventing Ca from entering cells NorEpi, glucago and neo helpful

35
Q

Vasopressin

A

alternative therapy when Epi fails, causes vasoconstriction via V1 receptors, directly decreases intracellular conc of NO, detrimental if used to early (WAIT 10-20min after onset of shock)

36
Q

Methylene blue

A

Interfere with NO mediated vascular smooth muscle relaxation, useful when catecholamin and vasopressin resitant anaphylaxis

37
Q

secondary tx

A

diphenhydramine (1-2mg/kg), hydrocortisone 2mg/kg, Inhaled bronchodilators, Aminophylline-resitant bronchospasm, inotrope infusion to maintain BP, NaHCO3 for acidosis

38
Q

Biologic assesment

A

assist in dx, biochemical tests in vivo and in vitro, inc in plasma histamin (drawn withn 30min short t1/2)

39
Q

Histamines

A

inc in plasma histamin (drawn withn 30min short t1/2), indicates Mast cell/basophil activation, does NOT diff immune vs non immune cause

40
Q

Tryptase- mast cell neutral serine protease

A

Preformed enzyme, elevated serum tryptase = mast cell/ basophil activation (peaks 15-60min) baseline tryptase (after 24hrs) determines immune and non immunologic mechanis

41
Q

Immunologic anaphylaxis

A

Inc serum histamine and tryptase

42
Q

Nonimmunologic

A

inc serum histamine NO CHANGE in tryptase

43
Q

Po-op management

A

Clotting screen, ICU, airway eval before extubation, skin testing intradermal vs RAST, ELISA, patient ed furture prophylaxis

44
Q

Intradermal Skin Test

A

Gold Std for IgE mediated rxns, ids culprit agentm proves mechanism allergic vs non allergic, safe alternative. Done 4-6wks after rxn

45
Q

Coomon anes offenders

A

NMBs 69%, Latex 12-16% children 76%, antibiotics 8%, Opiods (morphine ann meperidine) PABA ester LA, hynotics,

46
Q

NMB

A

Sux, atracurium, vecuronium, cross rxty btw sux and NMBAs, IgE type 1 and non IgE mivacurium

47
Q

Hypnotics

A

Thiopental, propofol (other hx ex Egg) Anaphylaxis may occur after an uneventful previous exposure

48
Q

Opiods

A

anaphylactoid more common due to direct histamine release, arterial and venodilation

49
Q

LA

A

PABA ester Type 1 IgE or cross rxty, Amide LA preservative agent

50
Q

Antibotics

A

PCN, cephalosporins (cross rxty 1-7%), PCN 50%. Vancomycin produces both rxn Redman syndrome-histamine release

51
Q

Latex

A

true rxn, delayed onset, increasing incidence in children

52
Q

High risk Latex

A

spina bifida, spinal cord injury, healthcare workers, allergy to bananas, avocado, kiwi

53
Q

Others

A

Blood products, Plasma volume expanders, IV contrast dye, Protamine, halothane hepatitis (neoag stimulate abs, eosinophilia rash fever, prior exposure to halothane

54
Q

Etiology and dx of periop anaphylaxis

A

Depends of clinical, biologic and allergologic evidence

55
Q

Etiology and dx of periop anaphylaxis

A

severe rxn+serum tryptase+ pos skin test =anaphylaxis

56
Q

Etiology and dx of periop anaphylaxis

A

suggestive clinical hx+ +/- serum histamine - serum tryptase+ neg skin test = non allergenic rxn

57
Q

death prevention

A

High index of suspicion, prompt recognition+ prompt and aggressive tx

Anes101 (10 decks)

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