perioperative anaphylaxis
- IV adrenaline
- Anaphylaxis
| 2021 changes: lie them down, IM adrenaline, refractory anaphylaxis algorithm added | |
|---|---|
| Presentation | • Unexplained hypotension, tachycardia, bradycardia, bronchospasm (wheeze may be absent if severe) • Unexpected cardiorespiratory arrest where other causes are excluded |
| Management | 1. Call for help + pause non-essential surgery 2. Remove suspected triggers if possible: Antibiotics, NMBAs, dyes, colloids, chlorhexidine coated lines/catheters, lubricants, latex 3. Adrenaline doses: 1. Adult and child > 12 years: 50 micrograms IV (0.5 mL IV of 1 mg/10 mL [1:10,000]) 2. Child < 12 years: 1 microgram/kg, needs careful dilution, titrate to effect 3. If no IV access: 10 micrograms/kg IM, (max 500 micrograms IM) of 1 mg/mL (1:1,000), and secure IV/IO access 4. Rapid IV fluid bolus 5. If systolic BP < 50 mmHg (or cardiac arrest), start CPR IF REFRACTORY TO ADRENALINE INFUSION: • Add a second vasopressor (noradrenaline or vasopressin) in addition to adrenaline • Consider glucagon 1 mg IV in adults on beta-blockers • Consider steroids for refractory reactions or shock • Consider extracorporeal life support |
You are allowed peripheral low dose adrenaline infusion - 0.5 mg (0.5 mL of 1 mg/mL [1:1000]) in 50 mL
• In both adults and children, start at 0.5–1.0 mL/kg/hour, and titrate according to clinical response
• Continuous monitoring and observation is mandatory