Tuesday, May 9, 2017

Peri-Intubation Anaphylaxis

R.E.B.E.L.EM - May 8, 2017 - By Rob Bryant - Peer reviewed by Salim Rezaie
"Background: Peri-operative anaphylaxis is an unexpected complication of intubation. The major life threat in anaphylaxis is typically loss of airway, however profound hypotension and circulatory collapse are still possible life threats even in the setting of a protected airway. Peri-operative anaphylaxis is considered an important enough issue to be the subject of the NAP 6 (National Audit Project) audit this year in Great Britain. (Reporting period November 2015 – November 2016)...
Clinical Take Home Points:
  • Be aware of anaphylaxis to NMB as a cause of post intubation hypotension.(1:2000-1:2500)
  • Sugammadex is unlikely to reverse rocuronium induced anaphylaxis.
  • If a patient has a neuromuscular blocking agent listed on their allergy list, this is a real entity, and cross reactivity to other agents can exist: proceed with caution, and consider a KSI (Ketamine Sequence Intubation)"