Mod12: Treatment of Anaphylaxis DuringAnesthesia Flashcards
Treatment of Anaphylaxis During Anesthesia
What does Primary treatment starts with?
Stop antigen administration
Treatment of Anaphylaxis During Anesthesia - Primary treatment
After stopping administration of the antigen, what must you do next in a patient with no advanced airway?
Maintain airway via preemptive instrumentation, and
Administer 100% oxygen to correct V/Q mismatch if suspected and prevent ischemia
Treatment of Anaphylaxis During Anesthesia - Primary treatment
True or False: during an anaphylaxis, it is appropriate to discontinue all anesthetic agents and wake the pt up if the surgical procedure allows it.
True
If the surgical procedure does not allow it, communicate with the surgeon to possibly shorten the procedure and complete it at a later time
Treatment of Anaphylaxis During Anesthesia - Primary treatment
Why would you consider additional IV access and arterial line as part of the primary treatment of anaphylaxis?
Volume expansion for hypotension
Strict BP monitoring
Treatment of Anaphylaxis During Anesthesia - Primary treatment
What’s the first Tx for hypontension during anaplylaxis?
Volume expansion
Treatment of Anaphylaxis During Anesthesia - Primary treatment
Why is volume expansion the first Tx for hypontension during anaplylaxis?
Up to 40 percent loss of intravascular fluid into the interstitial space d/t increased capillary permeability
Treatment of Anaphylaxis During Anesthesia - Primary treatment
Which solutions would you use for volume expansion in the Tx of hypontension during anaplylaxis?
25-50 ml/kg of
Lactated Ringer’s solution - Normal saline
(75% will move into the intertitial space after 30 min),
or
Colloid solutions
(beneficial d/t higher oncotic pressure)
Treatment of Anaphylaxis During Anesthesia - Primary treatment
How would you treat persistent hypotension resistant to initial volume expansion during anaphylaxis?
Additional volume
Treatment of Anaphylaxis During Anesthesia - Primary treatment
What are the three different ways Epinephrine is helpful in the Tx of anaphylaxis?
Inhibits mediator (histamine) release by increasing cyclic AMP in mast cells and basophils
(This stabilizes the cells and prevents degranulation)
Alpha1 effects to reverse hypotension
Beta2 effects for bronchodilation
Treatment of Anaphylaxis During Anesthesia - Primary treatment
A benefit of Epinephrine is that it has a rapid onset when given IV, but why are repeated doses necessary?
It has short duration
Treatment of Anaphylaxis During Anesthesia - Primary treatment
How much Epi would you give to treat hypotension a/w anaphylaxis?
5 - 10 mcg IV
Titrated doses for hypotension
Treatment of Anaphylaxis During Anesthesia - Primary treatment
How much Epi should you give to treat cardiovascular collapse a/w anaphylaxis?
0.1 - 1mg IV
Titrated doses for cardiovascular collapse
(Higher doses may be required for CV collapse - May also consider a continuous infusion)
Treatment of Anaphylaxis During Anesthesia - Primary treatment
Epinephrine is available in a very concentrated form. What is crucial that you do properly prior to administration?
Dilute it down appropriately to avoid administration of a massive dose
Treatment of Anaphylaxis During Anesthesia - Primary treatment
How could you administer Epi to treat anaphylaxis in patients with laryngeal edema without hypotension?
Subcutaneous
Treatment of Anaphylaxis During Anesthesia - Hypersensitive to Epinephrine
Patients taking which drugs may be hypersensitive to Epinephrine?
Tricyclic antidepressants
MAO inhibitors
Cocaine or other stimulants
(Concomitant administration of Epi to these pts may exhacerbate tachycardia and result in cardiac ischemia)
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
How much of which H1 receptor antagonist drug should you administer as secondary treatment in the Tx of anaphylaxis?
Benadryl 25 to 50 mg IV (up to 1.0 mg/kg)
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
How does Benadryl attenuate systemic effects in chemically mediated reactions responsible for anaphylaxis?
Via H1 and H2 receptors antagonism
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
True or False: Antihistamines inhibit histamine release
False
Antihistamines compete with histamine at receptor sites but do not inhibit histamine release
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
True or False: Benadryl (diphenhydramine), an H1 antagonist, blocks both H1 and H2 receptors
False
H1 antagonists do not block H2 receptors
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
True or False: Tagamet (cimetidine), Zantac (ranitidine), and Pepcid (famotidine), H2 antagonists, blocks both H1 and H2 receptors
False
H2 antagonists do not block H1 receptors
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
What are recommended doses for H2 antagonits?
Tagamet (cimetidine) 400 mg IV
Zantac (ranitidine) 150 mg IV
Pepcid (famotidine) 20 mg IV**
(** most commnonly given in the OR)
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
Why are Corticosteroids (0.25-1.0g hydrocortisone) beneficial in the Tx of anaphylaxis?
May alter the activation of other inflammatory cells following an acute reaction
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
Corticosteroids onset is 12 to 24 hours later. Why give then during an acute reaction?
May attenuate recurring or late-phase reactions
Useful in refractory bronchospasm or shock
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
Which corticosteroid is particularly useful in protamine reactions?
1 to 2 g of methylprednisolone (30 to 35 mg/kg)
Treatment of Anaphylaxis During Anesthesia - Secondary Treatment
Which drug will you administer to treat Bronchospasm refractory to epinephrine?
Inhaled ß2-adrenergic agents
(albuterol or terbutaline)