Mod12: Anaphylactic vs AnaphylactoidReactions Under Anesthesia Flashcards
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What percentage of all complications occurring during anesthesia are allergic reactions?
10%
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True or False: The Overall incidence of allergic reactions in anesthesia is high
False
The overall incidence of allergic reactiona in anesthesia is low:
1 in 10,000 to 1 in 20,000
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True or False: Allergic reactions in anesthesia are predictable
False
Allergic reaction in anesthesia are unpredictable
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
Even when managed appropriately, what’s the mortality rate a/w Life-threatening allergic reactions
3 to 10%
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
Even when managed appropriately, why is the mortality rate a/w Life-threatening allergic reactions so elevated
Allergic reactions are often resistant to treatment
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
When in the course of anesthesia do most (78%) of allergic reactions occur?
78% occur immediately following induction
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
Why do most (78%) allergic reactions occur immediately following induction?
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
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What percentage of allergic reactions occur during maintenance?
16%
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What percentage of allergic reactions occur during recovery?
6%
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What percentage of pts experience true IgE anaphylaxis
69%
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What percentage of pts experience non-IgE (anaphylactoid) reactions?
31%
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True of False: It is easy to distinguish between an anaphylactic and anaphylactoid reaction
False
Distinguishing between an anaphylactic and anaphylactoid reaction is difficult, especially as the allergic reaction is happening
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What’s the different between the management of anapylactic and anaplylactoid reactions?
No difference
In the moment we will react the same way regardless of the type of reaction
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
When is the diagnosis of Anaphylactic vs Anaphylactoid Reactions made?
Based on patient evaluation and outcome long after the reaction has occurred
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What’s the key distinction between Anaphylactic vs Anaphylactoid Reactions?
Immunoglobulin E (IgE)
Present in anaphylactic reactions,
Absent in anaphylactoid reactions
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
Since IgE is absent, what causes anaphylactoid reactions?
Direct release of mediators by mast cells
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True of False: Anaphylactoid reactions Do Not require prior sensitazation
True
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
Why are allergic reactions particularly difficult to diagnose during Anesthesia?
Multiple drugs are administered in rapid succession
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
When do allergic reactions usually occur?
Within minutes after injection
Onset can occur at any time
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What are allergic reactions usually the direct result of?
Allergy to a specific drug
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
What are late onset allergic reactions usually related to?
Sensitivity to latex, or
Volume expanding fluids
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
Which constituent of drugs could make diagnosis of an allergic reaction even more difficult?
Preservatives
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True or False: Severity and progression of symptoms from allergic reactions are the same among patients
False
Severity and progression of symptoms vary widely between patients
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True or False: Anaphylactic reaction are dose dependent
False
Anaphylactic reactions are dose Independent
From the initial exposure, the body has sensitized itself to notice even a minute amount of the trigger
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
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
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True or False: Anaphylactic reaction requires prior exposure
True
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
Anaphylactic vs Anaphylactoid Reactions Under Anesthesia
True or False: Anaphylactoid reactions require prior exposure
False
Prior exposure not needed
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 “<u>allergic reaction</u>” should be part of the differential diagnosis)
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
Anaphylactic vs Anaphylactoid Reactions - Clinical Features
What causes cyanosis during allergic reactions?
V/Q mismatching
Pt not ventilating appropriately
Anaphylactic vs Anaphylactoid Reactions - Clinical Features
What are possible initial signs of severe anaphylaxis?
Loss of consciousness
Convulsive episode (seizure)
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
Anaphylactic vs Anaphylactoid Reactions - Clinical Features
What is the most important sign that patients under anesthesia exhibit due to an allergic reaction?
Hypotension
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
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
Anaphylactic vs Anaphylactoid Reactions - Clinical Features
Hypotension is usually the first manifestation of an allergic reaction. Which complications immediately follow it?
Bronchospasm & Cutaneous flushing
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)
Anaphylactic vs Anaphylactoid Reactions - Clinical Features
What part of the body is mainly affected by edema during an allergic reaction?
the Face
Anaphylactic vs Anaphylactoid Reactions - Clinical Features
What may prevent early detection of urticaria or angioedema?

Draping
Bair hugger, etc.

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