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How to Survive in Anaesthesia - Part 5

Trong khi nhỏ các phản ứng dị ứng không phổ biến trong gây mê, chính phản ứng phản vệ hiếm gặp. Kịp thời điều trị, với sự nhấn mạnh về việc sử dụng đầu của epinephrine (adrenaline) thường sẽ dẫn đến một kết quả thành công. Một phản ứng phản vệ là một phản ứng quá mức đối với một protein hay chất nước ngoài tiếp xúc và nhạy cảm trước đã xảy ra. | emedicina 13 Anaphylactic reactions Whilst minor allergic reactions are not uncommon in anaesthesia major anaphylactic reactions are rare. Prompt treatment with the emphasis on the early use of epinephrine adrenaline will usually lead to a successful outcome. An anaphylactic reaction is an exaggerated response to a foreign protein or substance to which previous exposure and sensitisation has occurred. Histamine serotonin and other vasoactive substances are liberated in response to an IgE-mediated reaction. An anaphylactoid reaction results in the same clinical manifestations as an anaphylactic reaction but is not mediated by a sensitising IgE antibody. Previous exposure to a drug will not have occurred but susceptible individuals often have a history of allergies. Every anaesthetist should know and practise an anaphylaxis drill . The clinical manifestations of severe allergic reactions are shown in Box 13.1. Box 13.1 Signs of severe allergic drug reactions Pruritis Flushing Erythema Coughing on induction of anaesthesia Nausea vomiting and diarrhoea Angioedema Lar yngeal oedema with stridor Bronchospasm with wheeze Hypotension Cardiovascular collapse Disseminated intravascular coagulation Sudden death Although all anaesthetic drugs can cause severe allergic reactions the neuromuscular blocking drugs account for the majority of the triggering agents. Only about a third of these patients will have had previous exposure to the specific drug. Latex hypersensitivity is an 68 emedicina Anaphylactic reactions increasing cause of anaphylaxis and is found commonly 30-60 minutes after the start of surgery. Females are more likely to have a reaction than males. Treatment The management of an anaphylactic reaction should be considered in two stages immediate treatment secondary treatment. The following guidelines assume that the patient is a 70 kg adult in whom the diagnosis is not in doubt. Immediate management Box 13.2 Box 13.2 Anaphylaxis - immediate management Stop .