Perioperative Anaphylaxis NAP 6

Question 1

Incidence of perioperative anaphylaxis

Answer 1

1 in 10,000 anaesthetics

Question 2

Common triggers for perioperative anaphylaxis

Answer 2

1. Antibiotics (Teicoplanin)
2. Muscle relaxants
3. Chlorhexidine
4. Patent Blue Dye

Question 3

Patients most at risk of death following perioperative anaphylaxis

Answer 3

• Elderly
• Obesity
• Cardiac co-morbidities

Question 4

Common CFx of perioperative anaphylaxis

Answer 4

• Hypotension
• Bronchospasm (more likely in obesity or sux use)
• Rash rarer- more common as a late sign when skin reperfusion occurred

Question 5

Take away messages for the management of perioperative anaphylaxis from NAP 6

Answer 5

• Start CPR if systolic BP <50
• Aggressive fluid resuscitation
• Mast cell tryptase (0, 1, 24 hours)
• Follow up- duty of candour, letter to patient and GP, DATIX, allergy clinic referral, MHRA yellow card

Question 6

Management of peri-operative anaphylaxis

Answer 6

• A-E, call for help and cardiac arrest trolley
• IV adrenaline (adults and children >12yrs 50mcg IV, children <12yrs 1mck/kg IV)
• Fluid bolus- 500ml-1L bolus, 20ml/kg children. May need up to 3-5L
• Systolic <50mmHg start CPR
• Adrenaline infusion 0.5mg in 50ml at 0.5-1.0ml/kg/hr
• If refractory to adrenaline infusion consider glucagon 1mg IV (good for B-blocked patients) or add in vasopressin
• Consider steroids
• Consider ECMO

Question 7

Ring and Messmer Scale Anaphylaxis

Answer 7

Grade I - skin symptoms and/ or mild fever
Grade II - Tachycardia, hypotension, Nausea
Grade III - Respiratory disturbance, shock, bronchospasm
Grade IV - Cardiac arrest