Mod12: Anaphylactic vs AnaphylactoidReactions Under Anesthesia

Question 1

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 1

10%

Question 2

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 2

False

_{The overall incidence of allergic reactiona in anesthesia is low:}

1 in 10,000 to 1 in 20,000

Question 3

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

True or False: Allergic reactions in anesthesia are predictable

Answer 3

False

Allergic reaction in anesthesia are unpredictable

Question 4

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 4

3 to 10%

Question 5

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 5

Allergic reactions are often resistant to treatment

Question 6

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 6

78% occur immediately following induction

Question 7

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 7

_{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

Question 8

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

What percentage of allergic reactions occur during maintenance?

Answer 8

16%

Question 9

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

What percentage of allergic reactions occur during recovery?

Answer 9

6%

Question 10

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

What percentage of pts experience true IgE anaphylaxis

Answer 10

69%

Question 11

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 11

31%

Question 12

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 12

False

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

Question 13

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 13

No difference

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

Question 14

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

When is the diagnosis of Anaphylactic vs Anaphylactoid Reactions made?

Answer 14

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

Question 15

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 15

Immunoglobulin E (IgE)

Present in anaphylactic reactions,

Absent in anaphylactoid reactions

Question 16

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

Since IgE is absent, what causes anaphylactoid reactions?

Answer 16

Direct release of mediators by mast cells

Question 17

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

True of False: Anaphylactoid reactions Do Not require prior sensitazation

Answer 17

True

Question 18

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

Why are allergic reactions particularly difficult to diagnose during Anesthesia?

Answer 18

Multiple drugs are administered in rapid succession

Question 19

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

When do allergic reactions usually occur?

Answer 19

Within minutes after injection

Onset can occur at any time

Question 20

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

What are allergic reactions usually the direct result of?

Answer 20

Allergy to a specific drug

Question 21

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

What are late onset allergic reactions usually related to?

Answer 21

Sensitivity to latex, or

Volume expanding fluids

Question 22

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 22

Preservatives

Question 23

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

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

Answer 23

False

Severity and progression of symptoms vary widely between patients

Question 24

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia}

True or False: Anaphylactic reaction are dose dependent

Answer 24

False

Anaphylactic reactions are dose Independent

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

Question 25

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia} True or False: Anaphylactoid reactions are dose dependent

Answer 25

**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}

Question 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

Answer 26

Anaphylactic reaction

Question 27

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia} True or False: Anaphylactic reaction requires prior exposure

Answer 27

**True**

Question 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

Answer 28

Anaphylactoid reaction

Question 29

_{Anaphylactic vs Anaphylactoid Reactions Under Anesthesia} True or False: Anaphylactoid reactions require prior exposure

Answer 29

**False** Prior exposure not needed

Question 30

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} Which symptoms may an awake patient suffering from a potential allergic reaction complain of?

Answer 30

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)}

Question 31

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} Which symptoms may an awake patient suffering from a potential allergic reaction manifest?

Answer 31

Coughing - Wheezing - Stridor - Tachypnea Cyanosis - Facial swelling - Flare of histamine release Diaphoresis - Periorbital edema - Vomiting

Question 32

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} What causes cyanosis during allergic reactions?

Answer 32

V/Q mismatching Pt not ventilating appropriately

Question 33

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} What are possible initial signs of severe anaphylaxis?

Answer 33

Loss of consciousness Convulsive episode (seizure)

Question 34

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} What signs may patients under anesthesia exhibit due to an allergic reaction?

Answer 34

Hypotension - Tachycardia - Bronchospasm Pulmonary edema - Difficulty ventilating Circulatory collapse - ↓ O2 saturation Rapid ↑ or ↓ in ETCO2 - Urticaria - Erythema Facial edema - Perioral edema

Question 35

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} What is the most important sign that patients under anesthesia exhibit due to an allergic reaction?

Answer 35

Hypotension

Question 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?

Answer 36

Circulatory collapse

Question 37

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} Why are allergic reactions due to drugs more pronounced than environmental exposures?

Answer 37

Because the drug are given IV and reach the sytemic circulation immediately, bypassing skin or 1st pass metabolism

Question 38

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} Hypotension is usually the first manifestation of an allergic reaction. Which complications immediately follow it?

Answer 38

**Bronchospasm** & **Cutaneous flushing**

Question 39

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} What part of the body does flushing always affect during an allergic reaction?

Answer 39

The **entire body** ^{(Starting at the site of the IV access, spreading to the rest of the body)}

Question 40

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} What part of the body is mainly affected by edema during an allergic reaction?

Answer 40

the **Face**

Question 41

_{Anaphylactic vs Anaphylactoid Reactions - Clinical Features} What may prevent **early detection** of urticaria or angioedema?

Answer 41

Draping Bair hugger, etc.

Question 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?

Answer 42

Ventilators Alarms Difficulty ventilating Signs/Sx of Bronchospasm