Emergency treatment of peri‐operative anaphylaxis: Resuscitation Council UK algorithm for anaesthetists

Abstract

SummaryPeri‐operative anaphylaxis is a rare but potentially catastrophic event which must be considered whenever unexpected and significant cardiovascular or respiratory compromise occurs during anaesthesia. The Resuscitation Council UK algorithm for peri‐operative anaphylaxis highlights the importance of early intravenous adrenaline and fluid resuscitation and provides guidance on the treatment of refractory anaphylaxis and immediate follow‐up. This algorithm is endorsed by the Royal College of Anaesthetists, Association of Anaesthetists, British Society of Allergy and Clinical Immunology and Clinical Immunology Professional Network of the British Society for Immunology. This document was produced by the Perioperative Allergy Network steering committee in collaboration with the Resuscitation Council UK.

Perioperative anaphylactic shock caused by propofol

“…Den nationale behandlingsvejledning anfører, at ved kardiovaskulaert kollaps hos monitorerede patienter er der indikation for i.v. behandling med fortyndet adrenalin af personale med denne kompetence [3], hvilket også er anbefalingen i guidelines om perioperativ anafylaksibehandling [2].…”

“…Mange laegemidler er under mistanke, så allergiudredning er nødvendig. I litteraturen findes varierende estimater af incidensen svarende til mistanke om allergisk reaktion ved 1/18.600-1/353 anaestesier [1,2]. Årligt henvises ca.…”

Management of Refractory Anaphylaxis: An Overview of Current Guidelines

“…Australia-New Zealand (ASCIA) [29] IM, 10 μg/kg (max 0. Most guidelines for the treatment of anaphylaxis in the community or hospital setting flag the need to initiate and titrate IV adrenaline infusions for RA, that is persistence of features of anaphylaxis despite initial treatment with 2-3 doses of IM adrenaline, combined with adequate fluid therapy [10,14,16,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] (Tables 2 and 3). This recommendation is based on evidence from the management of other forms of distributive shock, case reports of severe human anaphylaxis and animal models of severe anaphylaxis [39,40]…”

“…Although adrenaline is the cornerstone of anaphylaxis treatment (IM for most settings, although in the perioperative setting, guidelines recommend the IV route) [14,16], the management of RA is less clear. RA can occur in the emergency setting, in perioperative settings, but also during food challenges [5,17].…”

Optimising peri‐operative anaphylaxis management: end‐tidal carbon dioxide monitoring and adrenaline titration

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We read with interest the guidelines from the Resuscitation Council UK on peri-operative anaphylaxis, particularly the recommendation for early administration of low-dose intravenous adrenaline [1]. While these guidelines

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