Mod12: Anaphylactic vs AnaphylactoidReactions Under Anesthesia Flashcards

1
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What percentage of all complications occurring during anesthesia are allergic reactions?

A

10%

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2
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

True or False: The Overall incidence of allergic reactions in anesthesia is high

A

False

The overall incidence of allergic reactiona in anesthesia is low:

1 in 10,000 to 1 in 20,000

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3
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

True or False: Allergic reactions in anesthesia are predictable

A

False

Allergic reaction in anesthesia are unpredictable

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4
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

Even when managed appropriately, what’s the mortality rate a/w Life-threatening allergic reactions

A

3 to 10%

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5
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

Even when managed appropriately, why is the mortality rate a/w Life-threatening allergic reactions so elevated

A

Allergic reactions are often resistant to treatment

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6
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

When in the course of anesthesia do most (78%) of allergic reactions occur?

A

78% occur immediately following induction

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7
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

Why do most (78%) allergic reactions occur immediately following induction?

A

Because at induction we give:

Large volumes of drugs

Many different types of drugs in a short period of time

Difficult to identify which drug may have caused the reaction

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8
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What percentage of allergic reactions occur during maintenance?

A

16%

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9
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What percentage of allergic reactions occur during recovery?

A

6%

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10
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What percentage of pts experience true IgE anaphylaxis

A

69%

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11
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What percentage of pts experience non-IgE (anaphylactoid) reactions?

A

31%

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12
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

True of False: It is easy to distinguish between an anaphylactic and anaphylactoid reaction

A

False

Distinguishing between an anaphylactic and anaphylactoid reaction is difficult, especially as the allergic reaction is happening

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13
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What’s the different between the management of anapylactic and anaplylactoid reactions?

A

No difference

In the moment we will react the same way regardless of the type of reaction

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14
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

When is the diagnosis of Anaphylactic vs Anaphylactoid Reactions made?

A

Based on patient evaluation and outcome long after the reaction has occurred

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15
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What’s the key distinction between Anaphylactic vs Anaphylactoid Reactions?

A

Immunoglobulin E (IgE)

Present in anaphylactic reactions,

Absent in anaphylactoid reactions

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16
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

Since IgE is absent, what causes anaphylactoid reactions?

A

Direct release of mediators by mast cells

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17
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

True of False: Anaphylactoid reactions Do Not require prior sensitazation

18
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

Why are allergic reactions particularly difficult to diagnose during Anesthesia?

A

Multiple drugs are administered in rapid succession

19
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

When do allergic reactions usually occur?

A

Within minutes after injection

Onset can occur at any time

20
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What are allergic reactions usually the direct result of?

A

Allergy to a specific drug

21
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

What are late onset allergic reactions usually related to?

A

Sensitivity to latex, or

Volume expanding fluids

22
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

Which constituent of drugs could make diagnosis of an allergic reaction even more difficult?

A

Preservatives

23
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

True or False: Severity and progression of symptoms from allergic reactions are the same among patients

A

False

Severity and progression of symptoms vary widely between patients

24
Q

Anaphylactic vs Anaphylactoid Reactions Under Anesthesia

True or False: Anaphylactic reaction are dose dependent

A

False

Anaphylactic reactions are dose Independent

From the initial exposure, the body has sensitized itself to notice even a minute amount of the trigger

25
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia True or False: Anaphylactoid reactions are dose dependent
**True** Direct mast cell response is a function of to the amount of drug given Smaller amount of a drug would cause less of an anaphylactoid reaction
26
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia Which allergic reaction is characterized by an immediate systemic reaction caused by rapid, IgE-mediated immune release of potent mediators from tissue mast cells and peripheral blood basophils
Anaphylactic reaction
27
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia True or False: Anaphylactic reaction requires prior exposure
**True**
28
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia Which allergic reaction is characterized by immediate systemic reactions that mimic anaphylaxis but are caused by nonimmune-mediated release of mediators or complement activation
Anaphylactoid reaction
29
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia True or False: Anaphylactoid reactions require prior exposure
**False** Prior exposure not needed
30
Anaphylactic vs Anaphylactoid Reactions - Clinical Features Which symptoms may an awake patient suffering from a potential allergic reaction complain of?
Nasal stuffiness - Itching - Dizziness Nausea or abdominal pain Difficulty swallowing - Chest tightness Difficulty breathing (These may have other causes, but "allergic reaction" should be part of the differential diagnosis)
31
Anaphylactic vs Anaphylactoid Reactions - Clinical Features Which symptoms may an awake patient suffering from a potential allergic reaction manifest?
Coughing - Wheezing - Stridor - Tachypnea Cyanosis - Facial swelling - Flare of histamine release Diaphoresis - Periorbital edema - Vomiting
32
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What causes cyanosis during allergic reactions?
V/Q mismatching Pt not ventilating appropriately
33
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What are possible initial signs of severe anaphylaxis?
Loss of consciousness Convulsive episode (seizure)
34
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What signs may patients under anesthesia exhibit due to an allergic reaction?
Hypotension - Tachycardia - Bronchospasm Pulmonary edema - Difficulty ventilating Circulatory collapse - ↓ O2 saturation Rapid ↑ or ↓ in ETCO2 - Urticaria - Erythema Facial edema - Perioral edema
35
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What is the most important sign that patients under anesthesia exhibit due to an allergic reaction?
Hypotension
36
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What could the inability to treat the Hypotension and Tachycardia in a pt suffering from an allergic reaction lead to?
Circulatory collapse
37
Anaphylactic vs Anaphylactoid Reactions - Clinical Features Why are allergic reactions due to drugs more pronounced than environmental exposures?
Because the drug are given IV and reach the sytemic circulation immediately, bypassing skin or 1st pass metabolism
38
Anaphylactic vs Anaphylactoid Reactions - Clinical Features Hypotension is usually the first manifestation of an allergic reaction. Which complications immediately follow it?
**Bronchospasm** & **Cutaneous flushing**
39
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What part of the body does flushing always affect during an allergic reaction?
The **entire body** (Starting at the site of the IV access, spreading to the rest of the body)
40
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What part of the body is mainly affected by edema during an allergic reaction?
the **Face**
41
Anaphylactic vs Anaphylactoid Reactions - Clinical Features What may prevent **early detection** of urticaria or angioedema?
Draping Bair hugger, etc.
42
Anaphylactic vs Anaphylactoid Reactions - Clinical Features If unable to visually detect urticaria or angioedema earlier, what other monitors and tools could you rely on?
Ventilators Alarms Difficulty ventilating Signs/Sx of Bronchospasm