Anaphylactic Reactions in Anesthesia and Intensive Care (eBook)

Front Cover 1
Anaphylactic Reactions in Anesthesia and Intensive Care 4
Copyright Page 5
Table of Contents 6
Preface 8
PART I: Mechanisms of Anaphylaxis 10
CHAPTER 1. Anaphylaxis, Allergy, and Immunology 12
PROPERTIES OF AN ANTIGEN 13
ANTIBODIES 13
CLASSIFICATION OF IMMUNOLOGIC REACTIONS 17
CHAPTER 2. IgE Anaphylaxis 22
INITIAL CELLULAR ACTIVATION 22
MAST CELLS AND BASOPHILS 23
FACTORS INFLUENCING ANAPHYLAXIS 24
ROLE OF CALCIUM 24
ONSET OF REACTION 25
SIGNS AND SYMPTOMS 26
INTRAOPERATIVE ANAPHYLAXIS 28
PATHOPHYSIOLOGY 30
PATHOLOGIC FINDINGS 34
CHAPTER 3. Mediators of Anaphylactic Reactions 38
STORED MEDIATORS 38
CHAPTER 4. Systems That Can Generate Immediate Hypersensitivity Reactions Independent of lgE 48
COMPLEMENT SYSTEM 48
PHARMACOLOGIC RELEASE OF HISTAMINE 52
COAGULATION AND FIBRINOLYSIS 57
PART II: Management of Anaphylaxis 60
CHAPTER 5. Common Anaphylactic and Anaphylactoid Reactions the Anesthesiologist Sees 62
ANESTHETIC AGENTS 64
OTHER AGENTS 69
CLASSIFICATION OF TRANSFUSION REACTIONS 71
CHAPTER 6. Preoperative Considerations in the Patient at Risk 84
MANAGEMENT OF THE ALLERGIC PATIENT 84
DETERMINING THE CAUSE OF ANAPHYLACTIC REACTIONS 86
USE OF TEST DOSES 92
PRETREATMENT FOR ANAPHYLACTIC/ANAPHYLACTOID REACTIONS 92
CHAPTER 7. General Approach to Anaphylactic Reactions 96
ADMINISTRATION OF SEDATIVE, HYPNOTIC, OR ANESTHETIC DRUGS 96
CARDIOGENIC SHOCK 97
DISCONNECTION OR OVERDOSAGE OF VASOACTIVE DRUG INFUSIONS 97
DYSRHYTHMIAS 97
HEREDITARY ANGIONEUROTIC EDEMA 98
JARISCH-HERXHEIMER REACTIONS 98
PERICARDIAL TAMPONADE 98
POSTEXTUBATION STRIDOR 98
PULMONARY EMBOLUS 99
SEPTIC SHOCK 99
TENSION PNEUMOTHORAX 100
VASOVAGAL REACTIONS 100
VENOUS AIR EMBOLISM 100
CHAPTER 8. Pharmacologie Therapy for Anaphylaxis 102
CATECHOLAMINES 102
AMINOPHYLLINE 107
CORTICOSTEROIDS 108
EXPERIMENTAL DRUGS 108
CHAPTER 9. A Therapeutic Protocol for the Management of Acute Anaphylaxis 112
INITIAL THERAPY 113
SECONDARY TREATMENT 118
CHAPTER 10. Managing Sequelae in the Recovery Room and Intensive Care Unit 122
HISTORY, PHYSICAL EXAMINATION, LABORATORY DATA 123
MONITORS 125
IRREVERSIBLE SHOCK 129
CHAPTER 11. Respiratory Management Following Anaphylaxis 130
INITIAL RESPIRATORY MANAGEMENT IN THE INTENSIVE CARE UNIT 131
CHAPTER 12. Human Physiologic Responses During Anaphylactic or Anaphylactoid Reactions 138
ANAPHYLACTOID REACTION TO VANCOMYCIN 138
SUSPECTED ANAPHYLAXIS TO CEFAZOLIN 140
ANAPHYLAXIS TO MEPERIDINE 142
SUSPECTED ANAPHYLAXIS TO PROTAMINE 145
ANAPHYLAXIS TO CHYMOPAPAIN DESPITE PRETREATMENT 148
SUMMARYPreventing Anaphylactic Reactions 152
REFERENCES 154
INDEX 178