Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Type 1 (acute)

A

Atopy, urticaria, angioedema, anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Type II (cytotoxic)

A

Hemolytic transfusion rx, HIT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Type III (immune complex)

A

Serum sickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Type IV (delayed)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anaphylaxis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anaphylaxis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anaphylaxis (clinical features)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Grade 1

A

Cutaneous mucus signs: erythema, urticaria, angiodema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Grade 2

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Grade 3

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Grade 4

A

Cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anaphylaxis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anaphylaxis (risk factors)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

productos of human mast cells

A

Granule proteins, cytokines, leukotrines, chemokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Important mediators

A

Histamines, LK, PG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Histamines

A

Inc cap perm, Peripheral vasodilation, Bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Leukotrienes (LK)

A

Bronchconstriction, inc cap perm, negative ionotropy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Prostaglandins (PG)

A

Bronchconstriction, vasodilations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Anaphylactoid

A

Non IgE anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions