CLEVELAND CLINIC FOUNDATION


TREATMENT OF ANAPHYLAXIS



Initial Therapy

 
 
 
 

1. Stop exposure to latex

 
 
 
 

2. Maintain the airway and administer 100% oxygen

 
 
 
 

3. Discontinue all anesthetic agents

 
 
 
 

4. Start intravascular volume expansion (2 - 4 litres of crystalloid if hypotension)

 
 
 
 

5. Give EPINEPHRINE

  • 5 - 10 ug initial bolus with hypotension, titrate as needed; 0.1 - 1 mg with cardiovascular collapse
  • Alpha adrenergic vasoconstriction to reverse hypotension
  • Beta stimulation bronchodilation and inhibition of mediator release

    The dose of epinephrine depends on patient's condition. The doses given for cardiovascular collapse will cause extreme hypertension if given to normotensive or moderately hypotensive patients.

    NOTE:

    1. If hypotension administer epinephrine IV

    2. If laryngeal edema without hypotension, administer epinephrine subcutaneously (300 - 500 ug or more)

    3. Patients under spinal or epidural anesthesia may require larger doses because of sympathetic block

    4. If IV access is not available, epinephrine can be given subcutaneously, in doses larger than would be administered intravenously (300 - 500 ug or more)

     
     
     
     


    Secondary Therapy

    1. Antihistamines (0.5 - 1 mg/kg diphenhydramine[Benadryl])

     
     
     
     

    2. Catecholamine infusions

     
     
     
     

    3. Corticosteroids (0.25 - 1 g hydrocortisone or 1 - 2 g methylprednisolone)

     
     
     
     

    4. Aminophylline (5 - 6 mg/kg over 20 minutes)

     
     
     
     

    5. Albuterol (4 - 12 MDI puffs via ETT)

     
     
     
     

    6. Sodium bicarbonate

     
     
     
     

    7. Airway evaluation

     
     
     
     


    NB. The surgery should either be terminated, or completed as rapidly as possible after stabilisation of the patient's condition.


    NB. Post-operatively your patient should be admitted to an ICU for 24 hours of observation.