Anaphylaxis in Anesthesia

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Questions and Answers

What could be a likely reason for a delayed allergic reaction after eating mammalian meats?

Cross-reactivity with seafood

Immediate hypersensitivity to poultry

Prior exposure to shellfish

Alpha-gal syndrome (correct)

Which factor is NOT considered a risk factor for anaphylaxis during anesthesia?

Vegetarian diet (correct)

Female sex

History of eczema

Previous anaphylaxis

What are the three components of the triad indicating anaphylaxis under anesthesia?

HoTN, Tachycardia, Bronchospasm (correct)

HoTN, Bronchospasm, Skin rash

Cyanosis, Respiratory distress, Hypoglycemia

Tachycardia, Hyperthermia, Bronchospasm

When should patients experiencing suspected anaphylaxis be evaluated?

4-6 weeks after the event Signup and view all the answers

Which of the following is a common severe reaction that can occur with anaphylaxis under anesthesia?

Circulatory collapse Signup and view all the answers

What should be included in the detailed description of an anaphylaxis event for evaluation?

Surgical instrument sterilization method Signup and view all the answers

What is a common consequence of an allergic reaction to protamine administration?

Higher risk of anaphylaxis Signup and view all the answers

What should be monitored immediately after an anaphylaxis event?

Serum tryptase levels Signup and view all the answers

What is the primary mechanism through which Type I (IgE) mediated allergic reactions occur?

Mast cells and basophils release chemical mediators Signup and view all the answers

Which pathway of complement activation does not require the presence of antibodies?

Alternative Pathway Signup and view all the answers

Which neuromuscular blocker is most commonly associated with anaphylaxis?

Succinylcholine Signup and view all the answers

What is the reported incidence of anaphylaxis for Sugammadex?

1 in 3500 to 1 in 64000 Signup and view all the answers

What percentage of perioperative allergic reactions are attributed to latex?

20% Signup and view all the answers

Which antibiotic is responsible for the majority of allergic reactions in the general population?

Penicillin Signup and view all the answers

Which of the following is a common hypothesis regarding 'Latex fruit syndrome'?

It involves cross-reactivity with certain fruits due to shared proteins. Signup and view all the answers

Which agent is known to cause histamine release but is not necessarily considered to cause anaphylaxis?

Atracurium Signup and view all the answers

What is one potential reaction when vancomycin is infused too quickly?

Red Man Syndrome Signup and view all the answers

Anaphylaxis due to animal-derived products is often attributed to which carbohydrate?

Galactose-alpha-1,3-galactose Signup and view all the answers

Which of the following may be used cautiously if a patient has a history of penicillin allergy?

2nd and 3rd generation cephalosporins Signup and view all the answers

What should be done if there is a documented latex allergy in a patient prior to surgery?

Establish a latex-free environment Signup and view all the answers

What is a rare but possible reaction from opioids administered intravenously?

Urticaria and flushing Signup and view all the answers

What are the potential reactions linked to alpha-gal syndrome after eating mammalian meats?

Delayed reactions such as bronchospasm or anaphylaxis Signup and view all the answers

Which of the following is a risk factor for anaphylaxis during anesthesia?

Female sex Signup and view all the answers

In a patient under anesthesia, which triad of symptoms is most indicative of anaphylaxis?

Hypotension, tachycardia, bronchospasm Signup and view all the answers

Which component should be recorded in detail when evaluating an anaphylactic event?

Timing of symptoms in relation to administered drugs Signup and view all the answers

What is a significant indicator of anaphylaxis severity during anesthesia?

Presence of serum tryptase levels post-event Signup and view all the answers

Which of the following conditions may contribute to an increased risk of anaphylaxis?

Asthma Signup and view all the answers

What factor differentiates anaphylactic reactions from other allergic responses under anesthesia?

Presentation as circulatory collapse Signup and view all the answers

When should serum tryptase levels be checked for effective evaluation of anaphylaxis?

Immediately after and again 24 hours after the event Signup and view all the answers

Which of the following mechanisms is responsible for the degranulation of mast cells during a Type I allergic reaction?

Binding of the allergen to cell membranes Signup and view all the answers

What is the primary agent responsible for the majority of allergic reactions in the general population?

Penicillin Signup and view all the answers

Following the administration of Sugammadex, how quickly can anaphylaxis occur?

Within the first minute Signup and view all the answers

What is the most common cause of perioperative allergic reactions attributed to latex?

Occupational exposure in healthcare workers Signup and view all the answers

In terms of allergic reactions in an anesthesia setting, what is a significant characteristic of NMBAs?

Cause the majority of allergic reactions under anesthesia Signup and view all the answers

Which of the following pathways can activate complement without antibodies?

Alternative pathway Signup and view all the answers

What is a characteristic of the histamine release caused by Atracurium?

It does not necessarily indicate anaphylaxis Signup and view all the answers

If a patient has a known allergy to Penicillin, which medication should be avoided?

Ancef Signup and view all the answers

What is a potential consequence of rapidly infused Vancomycin?

Flushing and hypotension Signup and view all the answers

Which best describes the incidence of anaphylaxis with Propofol?

1 in 30,000 Signup and view all the answers

In the context of Alpha-Gal syndrome, which of the following agents could be a trigger?

Gelatin-based colloids Signup and view all the answers

What should be prioritized if a patient with a known latex allergy is scheduled for surgery?

Create a latex-free environment Signup and view all the answers

Which of the following statements regarding NMBAs and anaphylaxis is true?

Second exposure typically leads to anaphylaxis after sensitization Signup and view all the answers

What specific symptom triad is indicative of anaphylaxis under anesthesia?

Hypotension, Tachycardia, Bronchospasm Signup and view all the answers

Which group of patients has an increased risk of experiencing anaphylaxis during anesthesia?

Patients with a history of multiple past surgeries and mast cell disorders Signup and view all the answers

When evaluating a patient for suspected anaphylaxis, which detail is least relevant?

List of hobbies and interests of the patient Signup and view all the answers

After an anaphylactic event, when should serum tryptase levels be measured for effective analysis?

Immediately after the event and 24 hours after the event Signup and view all the answers

Which of the following factors is NOT associated with increased risk for anaphylaxis?

Infrequent surgeries Signup and view all the answers

What type of allergic reaction is most commonly linked to alpha-gal syndrome?

Delayed allergic reactions after mammalian meat intake Signup and view all the answers

Which of the following conditions can increase the likelihood of an allergic reaction to protamine administration?

Prior history of anaphylaxis Signup and view all the answers

What aspect of anaphylaxis presentation is specifically noted to differ when patients are under anesthesia?

Presentation is more likely to involve circulatory collapse Signup and view all the answers

What is the most common mechanism leading to vasodilation during a Type I (IgE) allergic reaction?

Degranulation of mast cells Signup and view all the answers

What percentage of allergic reactions under anesthesia are attributed to neuromuscular blockers?

50-70% Signup and view all the answers

Which type of hypersensitivity reaction accounts for 60% of allergic reactions associated with anesthesia?

Type I (IgE) Signup and view all the answers

What action should be taken if a patient has a documented allergy to latex?

Establish a latex-free environment Signup and view all the answers

What is the primary reason for the cross-reactivity seen with penicillin and some cephalosporins?

Presence of the beta-lactam ring Signup and view all the answers

Which of the following best describes the timing of anaphylaxis after administration of Sugammadex?

Can happen within 1 minute of administration Signup and view all the answers

Which of the following agents is known to cause histamine release but not necessarily anaphylaxis?

Atracurium Signup and view all the answers

What is a common consequence of anaphylaxis associated with propofol administration?

Anaphylactic reactions are rare Signup and view all the answers

Which condition is a significant trigger for anaphylaxis related to animal-derived products?

Gelatin-based colloids Signup and view all the answers

What is the potential risk of rapidly infused vancomycin?

Hypotension and anaphylaxis Signup and view all the answers

Under what condition might a patient experience significant allergic reactions to iodine?

After exposure to contrast dye Signup and view all the answers

What characteristic of alpha-gal syndrome contributes to anaphylactic reactions?

Alpha-gal is present in mammalian tissues Signup and view all the answers

Which of the following agents is least likely to cause severe allergic reactions during an anesthesia setting?

Opioids Signup and view all the answers

Which response describes the activation pathways of the complement system?

Only the classical pathway requires antibodies Signup and view all the answers

What complication may arise from the administration of gelatin during anesthesia?

Potential for anaphylaxis Signup and view all the answers

Study Notes

Anaphylaxis in Anesthesia Overview

Anaphylaxis is a severe, potentially fatal allergic reaction that can occur during anesthesia.
Common triggers include antibiotics, neuromuscular blockers (NMBs), latex, chlorhexidine (CHG), and blood products.

Most Common Culprits

Antibiotics are the leading cause of anaphylaxis in the US.
Neuromuscular blockers are the second most common in the US, but the primary cause in the UK.
Other significant allergens include latex, CHG, and blood products.

Types of Allergic Reactions

Type I (IgE Mediated) Reactions: Primary type of anaphylactic reaction, occurring in 60% of cases.
Antigens stimulate mast cells and basophils, causing degranulation and release of mediators like histamine, leading to vasodilation and bronchoconstriction.
Initial localized reactions can escalate quickly as allergens spread through the bloodstream.

Pathophysiology

Anaphylaxis is marked by complement activation, a reaction cascade that can occur with or without antibodies.
Three pathways exist: Classical, MB-Lectin, and Alternative, all leading to the release of potent mediators and immune response activation.

Neuromuscular Blockers (NMBAs)

NMBAs account for 50-70% of allergic reactions during anesthesia.
Succinylcholine and rocuronium are common culprits; sensitization from first exposure often leads to anaphylaxis upon re-exposure.
Sugammadex can reverse anaphylaxis by binding rocuronium.

Antibiotics

Penicillin and its derivatives are responsible for about 70% of allergic reactions in the general population.
8-10% cross-reactivity observed with cephalosporins in penicillin-allergic patients; avoid if anaphylaxis occurred from penicillin.
Vancomycin should be administered slowly to prevent "Red Man Syndrome," characterized by flushing and hypotension.

Latex

Approximately 20% of perioperative allergies result from latex exposure.
"Latex fruit syndrome" relates to allergies involving fruits like bananas and avocados.
Establish latex-free environments for patients with a known latex allergy.

Skin Prep and Contrast Dye

Iodine and chlorhexidine may trigger allergy responses.
Radiologic contrast dyes can also be anaphylactic triggers used during surgical procedures.

Opioids

Commonly cause flushing and urticaria; life-threatening reactions are rare.
Morphine and meperidine may cause histamine release leading to reactions, including hypotension.

Fluids and Other Agents

Blood products and colloids can also cause anaphylaxis.
Specific agents like radiocontrast dye, NSAIDs, insulin, and local anesthetics are potential allergens.

Alpha-Gal Syndrome

An allergy to the carbohydrate galactose-alpha-1,3-galactose linked to mammalian-derived products.
Symptoms can occur hours after exposure, ranging from urticaria to anaphylaxis.

Anaphylaxis Prevention

Detailed patient histories regarding allergies are essential for risk assessment.
Prior anaphylaxis, female sex, and pre-existing conditions like asthma or eczema increase risk.
Close monitoring of patients with known allergies during anesthesia is critical.

Recognizing Anaphylaxis Under Anesthesia

Presents primarily as circulatory collapse with a triad of hypotension, tachycardia, and bronchospasm.
Serum tryptase measurement helps confirm anaphylaxis, with samples taken immediately and 24 hours post-event.

Treatment and Referral

Patients suspected of anaphylaxis should undergo evaluation within 4-6 weeks after the event to gather comprehensive data.
Detailed records should include surgical reports, symptoms, handling of medications, and any materials used during the procedure.

Anaphylaxis in Anesthesia Overview

Anaphylaxis is a severe, potentially fatal allergic reaction that can occur during anesthesia.
Common triggers include antibiotics, neuromuscular blockers (NMBs), latex, chlorhexidine (CHG), and blood products.

Most Common Culprits

Antibiotics are the leading cause of anaphylaxis in the US.
Neuromuscular blockers are the second most common in the US, but the primary cause in the UK.
Other significant allergens include latex, CHG, and blood products.

Types of Allergic Reactions

Type I (IgE Mediated) Reactions: Primary type of anaphylactic reaction, occurring in 60% of cases.
Antigens stimulate mast cells and basophils, causing degranulation and release of mediators like histamine, leading to vasodilation and bronchoconstriction.
Initial localized reactions can escalate quickly as allergens spread through the bloodstream.

Pathophysiology

Anaphylaxis is marked by complement activation, a reaction cascade that can occur with or without antibodies.
Three pathways exist: Classical, MB-Lectin, and Alternative, all leading to the release of potent mediators and immune response activation.

Neuromuscular Blockers (NMBAs)

NMBAs account for 50-70% of allergic reactions during anesthesia.
Succinylcholine and rocuronium are common culprits; sensitization from first exposure often leads to anaphylaxis upon re-exposure.
Sugammadex can reverse anaphylaxis by binding rocuronium.

Antibiotics

Penicillin and its derivatives are responsible for about 70% of allergic reactions in the general population.
8-10% cross-reactivity observed with cephalosporins in penicillin-allergic patients; avoid if anaphylaxis occurred from penicillin.
Vancomycin should be administered slowly to prevent "Red Man Syndrome," characterized by flushing and hypotension.

Latex

Approximately 20% of perioperative allergies result from latex exposure.
"Latex fruit syndrome" relates to allergies involving fruits like bananas and avocados.
Establish latex-free environments for patients with a known latex allergy.

Skin Prep and Contrast Dye

Iodine and chlorhexidine may trigger allergy responses.
Radiologic contrast dyes can also be anaphylactic triggers used during surgical procedures.

Opioids

Commonly cause flushing and urticaria; life-threatening reactions are rare.
Morphine and meperidine may cause histamine release leading to reactions, including hypotension.

Fluids and Other Agents

Blood products and colloids can also cause anaphylaxis.
Specific agents like radiocontrast dye, NSAIDs, insulin, and local anesthetics are potential allergens.

Alpha-Gal Syndrome

An allergy to the carbohydrate galactose-alpha-1,3-galactose linked to mammalian-derived products.
Symptoms can occur hours after exposure, ranging from urticaria to anaphylaxis.

Anaphylaxis Prevention

Detailed patient histories regarding allergies are essential for risk assessment.
Prior anaphylaxis, female sex, and pre-existing conditions like asthma or eczema increase risk.
Close monitoring of patients with known allergies during anesthesia is critical.

Recognizing Anaphylaxis Under Anesthesia

Presents primarily as circulatory collapse with a triad of hypotension, tachycardia, and bronchospasm.
Serum tryptase measurement helps confirm anaphylaxis, with samples taken immediately and 24 hours post-event.

Treatment and Referral

Patients suspected of anaphylaxis should undergo evaluation within 4-6 weeks after the event to gather comprehensive data.
Detailed records should include surgical reports, symptoms, handling of medications, and any materials used during the procedure.

Anaphylaxis in Anesthesia Overview

Anaphylaxis is a severe, potentially fatal allergic reaction that can occur during anesthesia.
Common triggers include antibiotics, neuromuscular blockers (NMBs), latex, chlorhexidine (CHG), and blood products.

Most Common Culprits

Antibiotics are the leading cause of anaphylaxis in the US.
Neuromuscular blockers are the second most common in the US, but the primary cause in the UK.
Other significant allergens include latex, CHG, and blood products.

Types of Allergic Reactions

Type I (IgE Mediated) Reactions: Primary type of anaphylactic reaction, occurring in 60% of cases.
Antigens stimulate mast cells and basophils, causing degranulation and release of mediators like histamine, leading to vasodilation and bronchoconstriction.
Initial localized reactions can escalate quickly as allergens spread through the bloodstream.

Pathophysiology

Anaphylaxis is marked by complement activation, a reaction cascade that can occur with or without antibodies.
Three pathways exist: Classical, MB-Lectin, and Alternative, all leading to the release of potent mediators and immune response activation.

Neuromuscular Blockers (NMBAs)

NMBAs account for 50-70% of allergic reactions during anesthesia.
Succinylcholine and rocuronium are common culprits; sensitization from first exposure often leads to anaphylaxis upon re-exposure.
Sugammadex can reverse anaphylaxis by binding rocuronium.

Antibiotics

Penicillin and its derivatives are responsible for about 70% of allergic reactions in the general population.
8-10% cross-reactivity observed with cephalosporins in penicillin-allergic patients; avoid if anaphylaxis occurred from penicillin.
Vancomycin should be administered slowly to prevent "Red Man Syndrome," characterized by flushing and hypotension.

Latex

Approximately 20% of perioperative allergies result from latex exposure.
"Latex fruit syndrome" relates to allergies involving fruits like bananas and avocados.
Establish latex-free environments for patients with a known latex allergy.

Skin Prep and Contrast Dye

Iodine and chlorhexidine may trigger allergy responses.
Radiologic contrast dyes can also be anaphylactic triggers used during surgical procedures.

Opioids

Commonly cause flushing and urticaria; life-threatening reactions are rare.
Morphine and meperidine may cause histamine release leading to reactions, including hypotension.

Fluids and Other Agents

Blood products and colloids can also cause anaphylaxis.
Specific agents like radiocontrast dye, NSAIDs, insulin, and local anesthetics are potential allergens.

Alpha-Gal Syndrome

An allergy to the carbohydrate galactose-alpha-1,3-galactose linked to mammalian-derived products.
Symptoms can occur hours after exposure, ranging from urticaria to anaphylaxis.

Anaphylaxis Prevention

Detailed patient histories regarding allergies are essential for risk assessment.
Prior anaphylaxis, female sex, and pre-existing conditions like asthma or eczema increase risk.
Close monitoring of patients with known allergies during anesthesia is critical.

Recognizing Anaphylaxis Under Anesthesia

Presents primarily as circulatory collapse with a triad of hypotension, tachycardia, and bronchospasm.
Serum tryptase measurement helps confirm anaphylaxis, with samples taken immediately and 24 hours post-event.

Treatment and Referral

Patients suspected of anaphylaxis should undergo evaluation within 4-6 weeks after the event to gather comprehensive data.
Detailed records should include surgical reports, symptoms, handling of medications, and any materials used during the procedure.

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Description

This quiz covers the critical aspects of anaphylaxis in anesthesia, focusing on the most common culprits such as antibiotics and muscle relaxants. It also highlights the types of allergic reactions, particularly Type I (IgE) mediated reactions, that can occur during anesthesia. Test your knowledge on this vital topic and ensure patient safety.