Anaphylaxis Differences between countries Anne Berit Guttormsen Department of Anaesthesia and Intensive Care, Haukeland University Hospital and Section for Anaesthesiology and Intensive Care, Department of Surgical Sciences, Medical Faculty, University of Bergen
47
Embed
Differences between countries - NSF Berit Guttormsen... · Bronkospasme Luftveisødem Ingen reaksjon Ventilasjon Kramper Annet ..... Ingen reaksjon CNS Brekning Annet ..... Ingen
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
AnaphylaxisDifferences between countries
Anne Berit GuttormsenDepartment of Anaesthesia and Intensive Care,
Haukeland University Hospital and Section for Anaesthesiology and Intensive Care,
Department of Surgical Sciences, Medical Faculty, University of Bergen
Aetiology
• Allergy is common, but progression of an allergic
reaction to a severe life-threatening condition is
rare.
• Most common causes of the life-threatening
reactions are drugs, stinging insects and food.
European Resuscitation council Guidelines for Resuscitation 2005
Early signs
• Urticaria
• Rhinitis
• Conjunctivitis
• Abdominal pain
• Vomiting and diarrhoea
• Flushing or pallor
European Resuscitation council Guidelines for Resuscitation 2005
Diagnosis is difficult
• Due to
– Lack of consistent clinical information
– A wide range of presentations
• Always exclude anaphylaxis as the cause
of the reaction.
– Misinterpretation might be fatal!
Anaphylaxis
• An acute general
hypersensitivity reaction– That takes place seconds/minutes
after exposure with the
drug/specimen in question
– The reaction involves one or more
organ systems
– The symptoms vary
• Often dramatic, potentially
lifethreatening
– Several mechanisms
• IgE/Non IgE
• Non allergic
Classification
• Grade 1: Symptoms from the skin, only
• Grade 2: Systemic, not lifethreatening
• Grade 3: Systemic, lifethreatening
• Grade 4: Asystoli/or respiratory arrest
• Grade 5: Death
Ring J, Messmer K. Lancet 1977
IgE-mediated
allergicNon-allergic
Codeine, NMBA,
fMLP, C3a, C3b etc .
Histamine
Cytokines
Tryptase, etc
CD63
Design; Anna Nopp/SGO
Johansson
Mechanisms
Patients
Patient 1 Male born 1972 (2006)
• He developed an itchy head, dizziness, facial oedema and
hypotension 10-20 minutes after taking cough-syrup containing ethyl
morphine.
• His wife suspected anaphylaxis and took him to hospital.
• On admission; BP was 84/58 mmHg, declining to 68/40 mmHg, and
he still had the facial oedema.
• He was treated with adrenaline, i.v. fluids, steroids and
antihistamines. He stabilized.
• Observed at the hospital for one night.
• (2005) Spinal anaesthesia, Bupivacaine with
fentanyl. After 50 minutes; Urticaria, face,
thorax lower part of abdomen and groins, itching
sensation on his palms. A small decrease in
blood pressure.
• Treatment
Ephedrine 10 mg, antihistamine and steroids
Patient 2 Male born 1935 (2005)
• (2001) Had Corsodyl mouth rinse – after surgery in the
mouth performed by the dentist. Five minutes after
exposure his body felt “itchy and strange”
• He left the dentist office, went to his car, turned the
switch, and 30 minutes later he woke up in the
Emergency Department, at the local hospital
• He lost his drivers licence for 3 months because doctors
thought he had a heart problem
• Although the patient was convinced that the reaction was
due to the mouth rinse
Patient 3 Pregnant female born 1962 (2006)
1987
• Forceps delivery – performed without general
anaesthesia. She was stable during the procedure
• Cervical laceration – suture in general anaesthesia
• Induction of general anaesthesia
– Fentanyl, Thiopenthone, Suxamethonium
• After induction she became cyanotic and
hypotensive
• Treatment: Rapid infusion of dextran, iv
ephedrine. Still low BP
• Reasons: Embolus to the lungs, amniotic fluid
embolus, sepsis or allergy.
1990
• Planned caesarean in general anaesthesia. She believes
that she will die during the procedure!
• Induction: Fentanyl, Thiopentone and suxamethonium.
• Reaction: BP dropped to 48 mm/Hg systolic.
Vasoconstriction, bronchospasm, cyanosis, oedema in
the face and the tongue.
• Treatment: Adrenaline 0,1 mg/ml in increments,
Ephedrine in increments and steroids
No follow-up – no warning card!
Patient 4 Female born 1942 Breast cancer surgery (2005)
• Daycare surgery
• Premedication; paracetamol and a NSAID
• Induction; remifentanil and propofol, circulation stable.
• Subcutaneous injection of Patent Blue (sentinal node)