Mod12: Anaphylactic vs Anaphylactoid Reactions - Differential Diagnosis - Prevention

Question 1

_{Anaphylactic vs Anaphylactoid Reactions - Differential Diagnosis}

When suspecting a hypersensitivity reaction, what else should you consider that is not necessary related to a hypersensitivity allergic reaction?

Answer 1

Vasovagal reaction - Ischemic heart disease

Cardiac arrhythmia - Seizure disorder

Carcinoid syndrome - Mastocytosis - Acute urticaria

Angioedema not attributable to an allergic reaction

Asthma/ bronchospasm - Aspiration

Pulmonary embolism - Kinked ETT

Surgical hypothermia in cold urticaria patients

Hypoglycemia - Hyperventilation syndrome - Panic attack

Question 2

_{Anaphylactic vs Anaphylactoid Reactions - Differential Diagnosis}

What else could you be doing while going through your Differential Diagnosis?

Answer 2

Treat presenting symptoms

Question 3

_{Anaphylactic vs Anaphylactoid Reactions - Prevention}

What could you do prior to surgery, to identify pts at risk for intraop allergic reactions and prevent such reactions from happening?

Answer 3

Complete an in-depth history of the following groups:

History of allergic reaction to anesthesia

Children with multiple surgeries

Females in their 40’s

Males in their 50’s

Latex sensitivity (F>M)

Question 4

_{Anaphylactic vs Anaphylactoid Reactions - Prevention}

How should you administer drugs to a pt with suspected hypersensitivity?

Answer 4

Administer drugs slowly

Question 5

_{Anaphylactic vs Anaphylactoid Reactions - Prevention}

What could you do before administering abx to a pt with suspected hypersensitivity?

Answer 5

Administer test dose prior to full dose

Question 6

_{Anaphylactic vs Anaphylactoid Reactions - Prevention}

Which drugs could you give preoperatively to significantly reduce tachycardia/bradycardia, hypotension, skin response, and even gastric pH changes induced by histamine release from some of the anesthetics

Answer 6

H1 and H2 blockers, (in combination)

Steroids

Would decrease the intensity of a reaction

Will Not prevent a reaction from occuring

Question 7

_{Anaphylactic vs Anaphylactoid Reactions - Prevention}

True or False: No specific treatment has been shown to reliably prevent the occurrence of anaphylaxis

Answer 7

True

That’s why “Allergy assessment” should be performed in all high-risk patients

Question 8

_{Anaphylactic vs Anaphylactoid Reactions - Prevention}

What’s is MANDATORY in your anesthetic technique when you know a pt is allergic to an agent?

Answer 8

Strict avoidance of the causative agent

Question 9

_{Anaphylactic vs Anaphylactoid Reactions - Prevention}

Which drugs could you rely on for for muscle relaxation in a pt with know reaction to muscle relaxants

Answer 9

Potent inhalation agents

Question 10

_{Anaphylactic vs Anaphylactoid Reactions - Prevention​}

Which drugs could you consider for pretreatment in known suspected reaction?

Answer 10

Antihistamines (H1 and H2 blockers)

Corticosteroids

Question 11

_{Anaphylactic vs Anaphylactoid Reactions - Prevention​}

During the preoperative interview, why must there be careful inquiry about possible predisposing factors, including known allergy or intolerance to drugs and/or foods, and associated signs and symptoms following exposure?

Answer 11

To allow you to determine what may have happened

Allows for proper selection of drugs

^{(Fentanyl vs morphine, NDMB vs Sux)}

Question 12

_{Anaphylactic vs Anaphylactoid Reactions - Prevention​}

During the preoperative interview any past history of reactions during anesthesia, reactions to contrast media or latex should be elicited. Which related piece information should be elicited as well?

Answer 12

Predisposing conditions, such as

mastocytosis or hereditary angioedema