angelique davis. type i ige or non-ige allergic reaction type ii igg, igm, complement mediated...
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Intraoperative Anaphylaxis
Angelique Davis
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Hypersensitivity Reactions Type I
• IgE or Non-IgE Allergic reaction Type II
• IgG, IgM, Complement mediated• Cytotoxicity; Blood reaction
Type III• Immune complex response• Clumps form due to not enough antibody to rid
antigen. Lupus, rheumatoid arthritis Type IV
• Delayed; T-cell mediated response• Bone marrow transplant rejection: Graft vs Host
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Type I Hypersensitivity reaction
ANAPHYLAXIS ANAPHYLACTOID
IgE mediated Previous exposure to
allergen Can occur once in every
5,000-10,000 anesthetics More frequent and more
severe Occurs within seconds to
5-10 minutes May be delayed onset
10-12 hours
Non-IgE mediated Can occur and act like
IgE mediated anaphylaxis upon first exposure to allergen
Idiopathic Less frequent Difficult to distinguish
between the two when reaction occurring
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Pathophysiology
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Pathophysiology Primarily concerned with mast cells
and basophils, which are mostly found in the heart, vasculature, respiratory, GI tract, and integument
Histamine release • Mucous secretion, edema, vasodilation,
tachycardia, inflammation, cardiac depression Leukotriene and prostagladin release
• Bronchoconstriction, angioedema, increased vascular permeability
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Early signs and symptoms Pruitis Malaise Dizziness Flushing Erythema Uticaria Angioedema
Can anyone tell me why these signs may be difficult to recognize?
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Late Signs and SymptomsRESPIRATORY CARDIOVASCULAR
Wheezing Hypoxia Hypercarbia Angioedema High peak
pressures
Hypotension Tachycardia Dysrhythmia's Shock Death
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Differential Diagnosis Bronchospasm Malginant Hyperthermia Laryngospasm Asthma Drug overdose Pulmonary Edema Pneumothorax Venous Air Embolism Pericardial tamponade Rapid infusion of vancomycin causes
flushing (red man syndrome)
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The Culprits Neuromuscular blocking
agents:• Succinylcholine at 33.4%• Rocuronium at 29.3%• Atracurium at 19.3%• Vecuronium at 10.2%
Due to the quaternary ammonium ions cross-sensitivity similar to the those in cosmetics, personal products, and drugs.
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The Culprits, con’dANTIBIOTICS LATEX
Beta-lactum Antibiotics• Penicillin's• Cephalosporin's
Vancomycin Quinolones
Latex containing gloves Catheters Tourniquets
More common in individuals that have had multiple surgeries in the past
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Treatment Remove causative agent Call for help Intubate or maintain airway 100% FiO2 Epinephrine 1:1,000 (α1, α2, β1, β2) Albuterol (β2 agonist) Fluid management (0.9% NaCl or colloid-
controversial) Histamine blockers (H1, H2) Corticosteroids
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Treatment Guide
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Emergency drug trayEpinephrine
Phenylephrine
Diphenhydramine
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Standard Drug Tray
Famotidine
Dexamethasone
Albuterol inhaler
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Refernces Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Anesthetic
Complications. In Morgan & Mikhail’s Clinical Anesthesiology (5th ed. (pp. 1199-1229). New York, NY: McGraw-Hill.
Ebo, D. G., Fisher, M. M., Hagendorens, M. M., Bridts, C. H., & Stevens, W. J. (2007). Anaphylaxis during anesthesia: diagnostic approach. Allergy,
62, 471-487. Jacobson, J., Lindekaer, A. L., Ostergaard, H. T., Nielsen, K., Ostergaard, D.,
Laub, M., ... Johannessen, N. (2001). Management of anaphylactic shock evaluated using a full-scale anesthesia simulator. ACTA Anaesthesiologica Scandinavica, 45, 315-319.
Mertes, P. M., Tajima, K., Regnier-Kimmoun, M. A., Lambert, M., Iohom, G., Gueant-Rodriguez, R. M., & Malinovsky, J. M. (2010, July).
Perioperative Anaphylaxis. Medical Clinics of North America, 94(4). Norred, C. L. (2012). Anesthetic-Induced Anaphylaxis. AANA Journal, 80,
129-140. O’Donnell, M. P. (2014). The Immune System and Anesthesia. In J. J.
Nagelhout, & K. L. Plaus (Eds.), Nurse Anesthesia (5th ed. (pp. 1015-1035). St. Louis, MO: Elsevier.