Document Detail

Anaphylaxis during cardiac surgery: implications for clinicians.
MedLine Citation:
PMID:  18227290     Owner:  NLM     Status:  MEDLINE    
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.
Jerrold H Levy; N Franklin Adkinson
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  106     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-29     Completed Date:  2008-02-19     Revised Date:  2008-10-09    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  392-403     Citation Subset:  AIM; IM    
Emory Hospital, 1364 Clifton Rd., Atlanta, GA 30322, USA.
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MeSH Terms
Anaphylaxis / diagnosis,  etiology,  prevention & control*
Cardiac Surgical Procedures / adverse effects*,  instrumentation
Environmental Exposure / adverse effects,  prevention & control
Intraoperative Complications / diagnosis,  etiology,  prevention & control*
Physicians* / standards
Practice Guidelines as Topic / standards
Comment In:
Anesth Analg. 2008 Oct;107(4):1441; author reply 1441   [PMID:  18806067 ]

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