Anaesthetic Emergencies

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Anaesthetic Emergencies

• Acute AnaphylaxisDr T E Allan Palmer FRCA FANZCA
  MDallan_at_palmer.net.au

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Presentation

• Primary indicators
• Unexplained hypotension
• Bronchospasm
• Angioedema
• More likely to be anaphylaxis if
• More than one feature
• Erythema, rash or urticaria
• Severe reaction

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Immediate Management

• Remove trigger agent
• Stop injection or infusion of drug
• Remove triggering materials
• Remember latex allergy
• Chlorhexidine
• Summon assistance
• Anaesthetist if in building, MET otherwise

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First Aid

• 100 Oxygen
• Secure airway
• Beware LMA.
• Stomach inflation
• Subglottic Oedema
• Volume Expansion
• Fluid that doesnt release histamine
• Hartmans initially
• 4 Albumen

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Definitive Management CVS

• IV adrenaline
• 110,000 1ml increments. Typically 5ml
• Need more if patient on beta blocker
• Repeat as needed
• Fast flowing IV
• Adrenaline infusion if reaction persists
• 1mg adrenaline in 50ml 3-60mls per hour
• May need triple dose
• CPR as needed

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Definitive Management RS

• Bronchospasm
• Systemic adrenaline first choice
• Nebulised salbutamol
• Steroids
• 1gm (ie 10amps hydrocortisone)
• 1gm methylprednisolone

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Monitoring

• ECG in all cases
• Acute myocardial infarction common if history IHD
• Blood pressure
• NIBP may read low due to low cardiac output
• Arterial line if in situ
• Hourly urine output
• CVP

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Ongoing Management

• HDU or ICU monitoring
• Ongoing adrenaline if needed
• Supportive care
• Safe airway
• Oxygenation
• Cardiovascular support

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Investigation

• Takes second place to treatment
• Mast Cell tryptase
• 1 to 4hrs after reaction and 6 weeks later
• Cross match tube. Call lab as has to be spun down
  and frozen
• History
• Detailed timeline of all events
• Subsequent skin testing

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Think About!

• Chlorhexidine allergy
• Skin prep, shower soap, central lines lignocaine
  gel!
• Latex allergy
• Particularly repeat exposures

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Questions

• What is wrong with subcutaneous or IM adrenaline?
• Why not use haemaccel if the blood pressure is
  low?
• First monitor to show any changes?