Safe and effective care of obese children demands careful perioperative management. High risk children are particularly vulnerable, and demand special attention. Bariatric surgery is an effective intervention for adolescents with severe obesity.
Anaphylaxis is an acute multisystem process resulting from allergic or nonallergic reactions to a foreign substance in the body. Regardless of trigger or pathophysiology, the mainstay of treatment is epinephrine. Common triggers of anaphylaxis in children undergoing anesthesia are latex, neuromuscular blocking agents, and antibiotics. Risk factors for latex sensitivity include frequent catheterization of the urogenital tract, atopic conditions, and mastocytosis. Presentation of anaphylaxis during anesthesia can be subtle or sudden, and cutaneous signs may be obscured by surgical drapes. A high index of suspicion facilitates prompt treatment with epinephrine, volume replacement, and airway management. Histamine and tryptase blood tests collected during the event can confirm the diagnosis acutely. Allergy consultation and skin testing may determine the causative agent.
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