Anafilaxia y anestesia
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CASO CLÍNICO
Sandra Milena Martínez R.Anestesia CES
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Mujer 82 años Tumor Páncreas HTA – ACV Dislipidemia
Qx: Gastrectomía Colelap
Safenectomia
Alérgica: Esteroides-
Antihistamínicos
Losartán –Lovastatina Naturistas
EF: PA:136/88 FC: 66 Peso:55Kg
Na: 132 K:3.5 Cl: 93
Historia
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8: 00 Preoxigenación, Midazolam 3mg, Fentanil 150mcg, Cisatracurio 10mg, TOT 7,5.PA: 107/63 FC: 58 SatO2: 100%
8:35 Profilaxis AB y Asepsia ChlorhexidinaEritema generalizado PA:34/25 FC: 118 SatO2: 92%
AB - Retirar Chlorhexidina – O2 100%, Cristaloides - Adrenalina
Historia
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¿Cuál es el diagnóstico?
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Anafilaxia
AlérgicaIgE
No Alérgica
Anafilactoide
Definición
Anaesthesia, 2009, 64, pages 199–211J Investig Allergol Clin Immunol 2011; Vol. 21(6): 442-453
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Epidemiología
Anaesthesia, 2009, 64, pages 199–211J Investig Allergol Clin Immunol 2011; Vol. 21(6): 442-453
Incidencia 1:10.000 a 1:20.000
Últimos 25 años: 7000
UK: 500 reacciones severas
Mortalidad 3 - 9%
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Manifestaciones Clínicas
J Investig Allergol Clin Immunol 2011; Vol. 21(6): 442-453
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¿Que otra cosa puede ser?
Med Clin N Am 94 (2010) 761–789
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Causas de Anafilaxia en el PerioperatorioAgente Incidencia Reacción Cruzada Test
RNM (Succinilcolina) 60% Común - Todos SPT / IT
Latex 20% Alimentos SPT
Antibióticos (Vancomicina) 15% Betalactámicos SPT / IT
Coloides 4% Gelatinas (95%) SPT / IT
Anestésicos Locales <1% NO SPT / IT
Opioides <1% - Provocación
Hipnóticos Raro Propofol? SPT
AINES - PGE2 Ltrienos SPT / IT
Halogenados NO REPORTES - -
Chlorhexidina ≠Paises No SPT / IT - IgE
Colorantes Raro Azul de Metileno SPT / IT
Comida Mar - NO PROTAMINA SPT / IT
Current Opinion in Anesthesiology 2011, 24:320–325
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Necesito algún exámen? Histamina – Tryptasa?
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J Investig Allergol Clin Immunol 2011; Vol. 21(6): 442-453
Med Clin N Am 94 (2010) 761–789
S: 75% E: 51%S: 64% E: 89%
Int Arch Allergy Immunol 2013;160:192–199
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Med Clin N Am 94 (2010) 761–789
✔
✔
✔
✔
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¿ Y si no funciona?
Med Clin N Am 94 (2010) 761–789J Investig Allergol Clin Immunol 2011; Vol. 21(6): 442-453UCI
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Current Opinion in Anesthesiology 2011, 24:320–325
EXPERTO!
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J Investig Allergol Clin Immunol 2011; Vol. 21(6): 442-453
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¿ Lo remito al Alergólogo?
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Anaesthesia, 2009, 64, pages 199–211
Criterios• Sospecha Anafilaxia• PC • Hipotensión• Broncoespasmo
resistente• Rash, urticaria,
angioedema
Incluir• Descripción detallada• Copia Registro
Anestésico• Exámenes• Datos Contacto
La Remisión…
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GRACIAS!