Management of anaphylactic shock in the operating room

Gouel-Cheron, Aurélie; Harpan, Adela; Mertès, Paul-Michel; Longrois, Dan

doi:10.1016/j.lpm.2016.04.002

Cited by 24 publications

(24 citation statements)

References 56 publications

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“…Acute haemoconcentration may be used to evaluate the adequacy of volume resuscitation. 65 Where available, fluid responsiveness indices or methods used to evaluate stroke volume or cardiac output (e.g. transthoracic or transoesophageal echocardiography) can assist management decisions by assessing ventricular function, filling, and vasodilation.…”

Section: Intravenous Fluid Administrationmentioning

confidence: 99%

“…transthoracic or transoesophageal echocardiography) can assist management decisions by assessing ventricular function, filling, and vasodilation. 65,66 In Grade IV reactions we recommend following ALS guidelines. Hypovolaemia is a cause of pulseless electrical activity, and relative hypovolaemia, requiring aggressive fluid therapy, and can be assumed in anaphylaxis.…”

Section: Intravenous Fluid Administrationmentioning

confidence: 99%

“…We recommend reevaluation and consideration of additional management strategies after 10 min where there is a sustained insufficient response despite adequate dosing of epinephrine and fluids. 41,65 Our recommendations include doubling the initial bolus dose of epinephrine and starting an epinephrine infusion after a total of three bolus doses. With persistent lifethreatening hypotension we recommend ensuring that an adequate volume of i.v.…”

Section: Management Of Refractory Anaphylaxismentioning

confidence: 99%

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Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Garvey

Dewachter

Hepner

et al. 2019

British Journal of Anaesthesia

147

178

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Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

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Section: Intravenous Fluid Administrationmentioning

confidence: 99%

Section: Intravenous Fluid Administrationmentioning

confidence: 99%

Section: Management Of Refractory Anaphylaxismentioning

confidence: 99%

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Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Garvey

Dewachter

Hepner

et al. 2019

British Journal of Anaesthesia

147

178

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“…They include myocardial depression, bradycardia, ischemia, and diastolic and systolic impairment. 33 Myocardial depression occurs secondary to the release of vasodepressor substances in anaphylaxis, including prostanoids and leukotrienes or some inflammatory cytokines (proposed mechanism). The role of cardiac mast cells in anaphylaxis has not been rigorously studied, but some data suggest coronary vasospasm with microischemia produce reduced systolic and diastolic function from histamine and PAF release.…”

Section: Mechanismsmentioning

confidence: 99%

“…34 The Kounis syndrome refers to acute coronary syndrome occurring as a complication of anaphylactic reactions and may occur as vasospastic disease or atherothrombotic coronary disease. 33 Finally, classical (transient hypokinesis or akinesis of the apical left ventricle) or reverse takotsubo syndromes (transient hypokinesis or akinesis of basal and mid-ventricular segments) have been implicated in case reports and series. 33 Combined distributive, hypovolemic, and cardiogenic features can produce a profound state of mixed shock.…”

Section: Mechanismsmentioning

confidence: 99%

Anaphylaxis

LoVerde

Iweala

Eginli

et al. 2018

Chest

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Anaphylaxis is a systemic, life-threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or nonallergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal, and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock. Often, these disorders can be appropriately managed in an outpatient setting; however, these conditions can be severe enough to warrant evaluation of the patient in the ED and in some cases, hospitalization, and management in an ICU. Reports suggest that underdiagnosis and undertreatment of anaphylaxis are common. Several new syndromes have been described recently including bird-egg, pork-cat, delayed allergy to mammalian meat and a diverse group of mast cell activation disorders. Conditions such as postural orthostatic tachycardia syndrome, carcinoid syndrome, Munchausen stridor, and factitious anaphylaxis can present similarly and need to be included in the differential diagnosis. Anaphylaxis is a clinical diagnosis, but plasma tryptase and urinary histamine levels are often elevated, allowing diagnostic confirmation; however, diagnostic testing should not delay treatment as results may not be immediately available. The sine qua non of treatment is avoidance of any known triggers and epinephrine, which should never be delayed if this disorder is suspected. Secondary treatments include fluids, bronchodilators, antihistamines, and glucocorticoids. Patients with cardiopulmonary arrest or airway or vascular compromise require mechanical ventilation, vasopressors, and other advanced life support in the ICU.

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Management of Anaphylaxis Refractory to Standard First Line Therapy

Hammond

Lieberman

2020

Anaphylaxis

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Management of anaphylactic shock in the operating room

Cited by 24 publications

References 56 publications

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Anaphylaxis

Management of Anaphylaxis Refractory to Standard First Line Therapy

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