Clinical Observations on the Pathophysiology and Treatment of Anaphylactic Cardiovascular Collapse

Abstract

Observations in 205 patients with cardiovascular manifestations of anaphylactic shock confirmed the belief that adrenaline is the drug of first choice in management and that colloid solutions are preferable to crystalloid solutions in volume replacement. Arrhythmias and elevated filling pressures are more common in patients with cardiac disease but the sympathetic response appears to override the cardiac effects of histamine in healthy patients.

Perioperative Anaphylaxis: What Should Be Known?

“…Fluid therapy is essential to compensate for the peripheral vasodilatation and the strong interstitial capillary leakage that occurs since the inaugural stage of anaphylaxis [12,[21][22][23]30]. In a few clinical reports, changes in vascular permeability caused plasma transfer into the interstitial space up to 35 % [45] and 73 % [46••] of blood volume, respectively, within 10 and 15 min following anaphylaxis onset. By comparison, in an experimental model, capillary leakage started within the first 3 min after anaphylaxis onset with an up to 25-fold increase during the first 10 min.…”

“…In addition, the exact fluid requirement during anaphylaxis remains unknown. Some authors therefore recommend that Blarge fluid therapy may be required over the first 15-30 min of anaphylaxis onset^ [46••], while others state Bthat colloids are preferable in order to compensate the significant volume deficit^ [45].…”

Intra-operative anaphylaxis caused by a pulmonary hydatid cyst

“…Eosinophilia detected in 30-50% of cases, is considered a nonspecific data although it indicates the strongly antigenic nature of the cyst fluid. Because of the extreme severity of the anaphylactic shock, there is an urge for early diagnosis and treatment for successful recovery 5 .…”

Fatal and Near-fatal Anaphylaxis

“…12 These findings were identified in patients with underlying cardiac disease resulting in greatly reduced blood volume reaching the left ventricle to support the blood pressure or cardiac output. Even in the absence of cardiac disease, patients can present with sudden-onset cardiovascular collapse, myocardial infarction, or ventricular fibrillation.…”