Anaes Vivas · Critical incidents & patient safety
Collapse minutes after an induction drug — anaphylaxis viva
A clinical viva on perioperative anaphylaxis: early declaration without a rash, adrenaline by route and dose, the NAP6 culprit ranking, the timed tryptase schedule, and mandatory allergy referral with panel testing.
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Prompt
Two minutes after rocuronium and cefazolin at induction, the blood pressure is 50 over 20, the peak airway pressure has jumped to 45, the saturation is falling, and there is no rash visible under the drapes. Talk me through your recognition, your first drug with its dose, and how you prove the diagnosis afterwards.
Stimulus
Two minutes after rocuronium and cefazolin at induction, the blood pressure is 50 over 20, the peak airway pressure has jumped to 45, the saturation is falling, and there is no rash visible under the drapes. Talk me through your recognition, your first drug with its dose, and how you prove the diagnosis afterwards[2][5].
References6ShowHide
- [1]Harper NJN, Cook TM, Garcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6) Br J Anaesth, 2018.PMID 29935569
- [2]Harper NJN, Cook TM, Garcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6) Br J Anaesth, 2018.PMID 29935567
- [3]Marinho S, Kemp H, Cook TM, et al. Cross-sectional study of perioperative drug and allergen exposure in UK practice in 2016: the 6th National Audit Project (NAP6) Allergen Survey Br J Anaesth, 2018.PMID 29935566
- [4]Wang J, Lieberman JA, Wallace DV, et al. Anaphylaxis in Practice: A Guide to the 2023 Practice Parameter Update J Allergy Clin Immunol Pract, 2024.PMID 38944199
- [5]Harper NJ, et al. Suspected anaphylactic reactions associated with anaesthesia Anaesthesia, 2009.PMID 19143700
- [6]Dodd A, Hughes A, Sargant N, et al. Evidence update for the treatment of anaphylaxis Resuscitation, 2021.PMID 33895231