RT Book, Section
A1 Leader, Alexandra P.
A1 Dunst, Ryan
A1 Andreae, Michael H.
A2 Atchabahian, Arthur
A2 Gupta, Ruchir
SR Print(0)
ID 57263591
T1 Chapter 201. Anaphylaxis
T2 The Anesthesia Guide
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-176049-2
LK accessanesthesiology.mhmedical.com/content.aspx?aid=57263591
RD 2024/04/24
AB Potentially  lethal  allergic  reactionRapid  onset,  from  minutes  to  hours  after  exposureGenerally  requires  a  prior  sensitization  to  antigen;  can  occur  on  first  exposure  due  to  cross-reactivity  among  drugs/productsPathophysiology:  type  I  hypersensitivity  reaction  involving  multiple  organ  systems  IgE-mediated  mast  cell  degranulation  with  release  of  stored  histamine,  proteases,  proteoglycans,  and  platelet-activating  factor  (PAF);  followed  by  production  of  proinflammatory  prostaglandins  and  leukotrienesHistamine,  prostaglandin,  and  leukotriene  receptors  elicit  changes  in  vascular  permeability  and  tone,  bronchial  smooth  muscle  contraction,  and  coagulability,  and  may  produce  angioedema,  urticaria,  bronchoconstriction,  and  DIC;  PAF  can  further  contribute  to  anticoagulation  and  constriction  of  bronchial  smooth  muscleClinically  indistinguishable  from  anaphylactoid  reactions,  that  is,  “pseudoanaphylaxis”  (non-IgE-mediated,  no  prior  sensitization,  nonspecific  histamine  release)Incidence  1/3,500–20,000  anesthetic  procedures;  higher  mortality  rate  in  perioperative  anaphylaxis  than  anaphylaxis  in  other  settingsEarly  signs  often  unrecognized  and  undertreated  in  anesthetized  patients;  cutaneous  signs  masked  by  surgical  drapingMay  be  biphasic  with  recurrence  of  symptoms  8–10  and  up  to  72  hours  after  initial  occurrenceRequires  immediate  treatment  and  resuscitationDeath  from  upper  airway  edema,  bronchial  obstruction,  circulatory  collapseComorbidities  with  high  risk  of  poor  outcomes:  asthma/COPD  and  CV  diseaseFour  grades:  Cutaneomucosal  generalized  signs:  rash,  urticariaModerate  multivisceral  involvement:  hypotension,  tachycardia,  bronchial  hyperreactivitySevere,  life-threatening  multivisceral  involvement:  MI,  severe  bronchospasmCardiorespiratory  arrest