Anaphylaxis during cardiac surgery: implications for clinicians.

Abstract:

:During surgery, patients are exposed to multiple foreign substances including anesthetic drugs, antibiotics, blood products, heparin, polypeptides (aprotinin, latex, and protamine), and intravascular volume expanders, which have the potential to produce life-threatening allergic reactions termed "anaphylaxis." The hallmark of perioperative anaphylaxis is acute cardiovascular and pulmonary dysfunction. Patients undergoing cardiac surgery have extensive monitoring that permits rapid recognition and treatment when anaphylaxis occurs. Initial, smaller doses of drugs, often called test doses, administered before the therapeutic dose may produce anaphylaxis, and so clinicians need to be prepared to treat reactions if they occur. Institution of cardiopulmonary bypass for hemodynamically unstable patients can be a life-saving maneuver, and should be considered in patients with refractory cardiovascular dysfunction. Arginine vasopressin should also be considered for patients with vasodilatory shock. In this review, we focus on recent concepts in understanding the incidence and management approaches for patients at risk for anaphylaxis in the operating room setting, with an emphasis on cardiac surgical patients.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Levy JH,Adkinson NF Jr

doi

10.1213/ane.0b013e3181602e0d

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

392-403

issue

2

eissn

0003-2999

issn

1526-7598

pii

106/2/392

journal_volume

106

pub_type

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