perioperative anaphylaxis

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Perioperative anaphylaxis Presented by Chuleeporn Kongmeesook, MD May22, 2014

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  • 1.PerioperativePerioperativePerioperativePerioperativePerioperativePerioperativePerioperativePerioperative AnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxis CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.

2. OutlineOutline EpidemiologyEpidemiology Causal agentsCausal agents InvestigationInvestigation InvestigationInvestigation ManagementManagement 3. EpidemiologyEpidemiology Other countries varies widelyOther countries varies widely 1/1,7001/1,700 -- 1/20,0001/20,000 In France 1/13,000In France 1/13,000 In Australia 1/10,000In Australia 1/10,000 -- 1/20,0001/20,000 MortalityMortality rate 5rate 5--7%7% A.V.A.V. MichavilaMichavila Gomez et alGomez et al AllergolAllergol ImmunopatholImmunopathol 20132013;; 11--1212 ((article in pressarticle in press)) PMPM MertesMertes, et al, et al J Investig Allergol Clin ImmunolJ Investig Allergol Clin Immunol 20112011;; 2121((66) :) : 442442--453453 P. W. Ewan et al Clinical & Experimental AllergyP. W. Ewan et al Clinical & Experimental Allergy 20102010;; 4040 :: 15153131 Middleton'sMiddleton's allergy:principlesallergy:principles and practiceand practice 88thth editionedition 4. Epidemiology in ThailandEpidemiology in Thailand PerioperativePerioperative allergic reactions 1/5,500allergic reactions 1/5,500 SomboonSomboon ThienthongThienthong et al J Med Assoc Thai 2005; 88 (7) : 128et al J Med Assoc Thai 2005; 88 (7) : 128--3333 5. Paul MichelPaul Michel MertesMertes et alet al J Allergy Clin Immunol 2011; 128 : 366J Allergy Clin Immunol 2011; 128 : 366--7373 6. SomboonSomboon ThienthongThienthong et al J Med Assoc Thai 2005; 88 (7) : 128et al J Med Assoc Thai 2005; 88 (7) : 128--3333 7. Paul MichelPaul Michel MertesMertes et al Anesthesiology 2003; 99:536et al Anesthesiology 2003; 99:5364545 8. Paul MichelPaul Michel MertesMertes et alet al J Allergy Clin Immunol 2011;128:366J Allergy Clin Immunol 2011;128:366--7373 9. HistoryHistory EExxtteenntt ooff ssiiggnsns DrDruuggss aanndd rreellaatteedd ccoommpopouunnddss TiTimmee eellaappsedsed bbeettweenween adadmmiinniissttrarattiioonn aanndd ononsetset ooff ssyymmppttoomsms PPrerevviioouuss aalllleerrggiieses ffrroomm ddrruuggss oorr rerellaatteded ccoommpopouunndsds UUnnddererllyyiinngg ccoonnddiittiiononss D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 10. EExxtteenntt ooff ssiiggnsns Most case ofMost case of perioperativeperioperative anaphylaxisanaphylaxis characterized by severe respiratory andcharacterized by severe respiratory and cardiovascular manifestationscardiovascular manifestations D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 11. Paul MichelPaul Michel MertesMertes Anesthesiology 2003; 99:536Anesthesiology 2003; 99:5364545 12. PMPM MertesMertes et alet al J Investig Allergol Clin Immunol 2011; 21(6): 442J Investig Allergol Clin Immunol 2011; 21(6): 442--453453 13. Paul MichelPaul Michel MertesMertes AnesthesiologyAnesthesiology 20032003;; 9999::5365364545 14. Most common are NMBAs, latex andMost common are NMBAs, latex and antibioticsantibiotics DrDruuggss aanndd rreellaatteedd ccoommpopouunnddss D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 15. D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 16. Clinical signs and symptoms usually startClinical signs and symptoms usually start within 5within 510 min after administration but10 min after administration but can occur within secondcan occur within second TiTimmee eellaappsedsed bbeettweenween adadmmiinniissttrarattiioonn aanndd ononsetset ooff ssyymmppttoomsms Natural rubber latex (NRL) and antisepticsNatural rubber latex (NRL) and antiseptics delayed onset and occurs duringdelayed onset and occurs during maintenancemaintenance anaesthesiaanaesthesia or recoveryor recovery D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 17. P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 15P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 153131 18. CCareareffuull rreettrroossppectectiivvee assessmassessmeenntt ooff mmeeddiicalcal hhiissttooryry aanndd rreeccoordsrds IIddeennttiifyfy rriisksk ooff ppaattiieennttss dduurriinngg PPrerevviioouuss aalllleerrggiieses ffrroomm ddrruuggss oorr rerellaatted ced coommpopouunndsds IIddeennttiifyfy rriisksk ooff ppaattiieennttss dduurriinngg pprereananesestthheetiticc vviissiitt D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 19. IdentIdentiiffiication of ucation of unnddererllyyiinngg ccoonnddiittiioonsns hheellpp ttoo iiddeenntitiffyy ccaauusasattiivvee ccompompooununddss AAttooppiicc rriisksk forfor aannaapphhyyllaaxxiis fs frroomm NNRRLL UUnnddererllyyiinngg ccoonnddiittiiononss AAttooppiicc rriisksk forfor aannaapphhyyllaaxxiis fs frroomm NNRRLL D. G.D. G. EboEbo et al Allergyet al Allergy 20072007;;6262:: 471471487487 20. Paul MichelPaul Michel MertesMertes Anesthesiology 2003; 99:536Anesthesiology 2003; 99:5364545 21. Paul MichelPaul Michel MertesMertes Anesthesiology 2003; 99:536Anesthesiology 2003; 99:5364545 22. InvestigationInvestigation SerumSerum tryptasetryptase Skin testSkin test Serum specificSerum specific IgEIgE antibodiesantibodies Serum specificSerum specific IgEIgE antibodiesantibodies Other tests :Other tests : BasophilBasophil activation testactivation test P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 15P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 153131 23. SerumSerum tryptasetryptase Recommended 60Recommended 60120 min after onset of120 min after onset of symptomssymptoms TryptasesTryptases halfhalf--life about 120 minlife about 120 min New sample should collect >2 days afterNew sample should collect >2 days after reaction for comparison with baselinereaction for comparison with baseline levelslevels D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 24. D. G.D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471487487 25. P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 15P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 153131 26. P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 15P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 153131 27. TreatmentTreatment David L.David L. HepnerHepner et alet al AnesthAnesth AnalgAnalg 2003;97:13812003;97:13819595 28. THANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOU 29. Paul MichelPaul Michel MertesMertes AnesthesiologyAnesthesiology 20032003;; 9999::5365364545