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Allergic Response in the OR
Final
43
Nursing
Graduate
12/02/2015

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Term
T Cells
Definition

Thymus derived cells that have receptors that are activated by binding with foreign antigens

 

Secrete mediators that influence the response of other cell types involved in the recognition and destruction of foreign substances 

Term
B Cells
Definition

Differentiate into specific plasma cells that synthesize antibodies

 

aka bursa derived cells 

Term
Types of Antibodies
Definition

"GAMED"

 

IgG

IgA

IgM

IgE

IgD

Term
IgE
Definition

Cause the release of histamine and other chemicals that cause allergic reactions

 

Main player in anaphylaxis 

Term
Effector Cells
Definition

Monocytes and Macrophages

 

Neutrophils (aka polymorphic leukocytes)

 

Eosinophils

 

Mast Cells (histamine releasing)

Term
Cytokines/Interleukins
Definition

Inflammatory cell activators synthesized by macrophages to act as secondary messengers and activate endothelial cells and WBCs 

 

Interleukin causes histamine release and bronchospasm

Term
Complement System
Definition

System of 20 differnt proteins that bind to activated antibodies, cell membranes, and other complement proteins

 

Primary humoral response 

Term
Effects of Anesthesia on Immune System
Definition

DEPRESSES nonspecific host resistance 

 

Affected by anesthetic drugs, other effects of drugs used in surgery, surgery itself, coincident infections, and blood products 

Term
Type I Reaction
Definition

Anaphylactic or Immediate reaction (minutes to an hour post exposure) 

 

Caused by antigen bining to IgE antibodies (mast cells released mediators-histamine)

 

Need to have PREVIOUS exposure to antigen 

 

Symptoms can last up to 36 hrs 

Term
S/Sx of Type I reaction
Definition

Anaphylaxis

 

Extrinsic Asthma

 

Urticaria (hives)

 

Allergic Rhinitis

 

Angioedema (especially laryngeal)

 

HOTN

 

Wheezing/Bronchospasm

 

Arryhtmias 

Term
Anaphylactoid
Definition

Non-IgE-mediated reaction caused by histamine release from basophils and mast cells

 

symptoms usually less severe

Term
Type II Reaction
Definition

"Cytotoxic"

 

Antibody-dependent cell-mediated cytotoxic hypersensitivity 

 

IgG and IgM

 

Cell damage: direct lysis, increased phagocytosis, killer-T cells produce cytotoxic effects

 

Ex. ABO incompatible tranfusions reactions, drug induced hemolytic anemia, HIT 

Term
Type III Reaction
Definition

" Immune Complex"

 

Antigen/Antibody complexes deposit in microvasculature

 

Complement is activated and neutrophils are localized to site of complement deposition which produces tissue damage

 

Ex. serum sickness, snake antisera, protamine mediated pulmonary vasoconstriction 

Term
Type IV Reaction
Definition

"Delayed"

 

Results from interactions of sensitized lymphocytes with specific antigens= delayed hypersensitivity

 

Manifests 18-24 hrs and disapppears 72-96 hrs later

 

Ex. Contact dermatitis, tissue rejection, GVHD 

Term
Respiratory Signs of Anaphylaxis
Definition

Coughing

 

Wheezing

 

Laryngeal edema

 

Decreased pulmonary compliance

 

Pulmonary Edema

 

Respiratory Failure 

Term
Cardiovascular Signs of Anaphylaxis
Definition

Disorientation

 

Diaphoresis

 

LOC changes

 

HOTN

 

Tachycardia

 

Dysrhythmias

 

Decreased SVR

 

CV arrest

 

Pulmonary HTN

Term
Cutaneous Signs of Anaphylaxis
Definition

Urticaria (hives)

 

Flushing

 

Periorbital edema

 

Perioral edema 

Term
H1 activation
Definition

Releases endothelium derived releasing factors- NO

 

Increases capillary permeability

 

Constricts airway and vascular smooth muscle 

Term
H2 Activation
Definition

Causes gastric secretion

 

Inhibits mast cell activation

 

Contributes to vasodilation 

Term
IgE Mediated Pathophys
Definition

Peptide Mediators

 

Arachidonic Metabolities

 

Kinins

 

Platlet Aggregating Factors 

Term
Peptide Mediators
Definition
Released from mast cells and basophils that cause chemotaxis and collection at the site of inflammation
Term
Arachidonic Metabolities
Definition
Leukotrienes and Prostaglandins are both synthesized after mast cell activation from arachidonic acid metabolism of phospholipid membrane
Term
Kinins
Definition

Synthesized in mast cells and basophils to produce vasodilation, increased capillary permeability, and bronchoconstriction

 

Can stimulate vascular endothelium to release prostacyclin and NO 

Term
Platlet Aggregating Factor
Definition
Aggregates and activates human platlets to release inflammatory products
Term
Non-IgE Mediated Response
Definition

Complement Activation- release biologicall active complement fragments of C3 and C5

 

C3 and C5 release histmaine from mast cells and basophils, contract smooth muscle, increase capillary permeability, and cause interleukin synthesis (bronchoconstriction) 

 

It is a non-immunologic release of histamine 

Term
Antihistamine Pretreatment
Definition

Drug competes with histamine at receptor sites

 

Do NOT prevent the release...just keep it from binding

 

H1 and H2 need to block both 

Term
Drugs that Cause NonImmunologic Histamine Release
Definition

Antibiotics (vanc)

 

Basic Compounds

 

Muscle Relaxants (NMB)

 

Opioids (Morphine and Demerol)

 

Thioibarbiturates 

Term
Lab Testing
Definition

Leukocytes Histamine Release 

 

Radioallergosorbent Test (RAST)

 

Enzyme-Linked Immunosorbent Assay (ELISA)

 

Intradermal Testing (Skin Testing) 

Term
Agents Most Likely To Trigger Reactions
Definition

NMBs

 

Latex

 

Antibiotics

 

Other (contrast, protamine, etc.)

 

Colloids

 

Opioids

 

Hypnotics

 

LA 

Term
Latex
Definition

Contain perservatives, accelerators, antioxidants

 

Healthcare workers, spina bifida, GU abnormalities

 

Bananas, Avocado, Kiwi

Term
NMBs
Definition
Divalent- capable of cross linking cell surface IgE and causing mediator release from mast cells and basophils without binding to larger carrier molecule
Term
Treament of Anaphylaxis
Definition

Airway Maintenance 

 

100% O2

 

IV Volume Expansion

 

Epinephrine 

 

Stops all anesthetic drugs- treat hypoxia and hypotension

Term
Volume Expansion During Anaphylaxis
Definition

40% loss due to 3rd spacing

 

2-4 L LR (adults)

 

25-50 ml/kg cyrstalloids- additional benefit 

Term
Epinephrine in Anaphylaxis
Definition

CV Unstable: 5-10 mcg IV bolus, 0.1-1 mg infusion with CV collapse

 

CV Stable: 0.1-0.5 mg  SC/IM

Term
Benedryl
Definition
0.5-1 mg/kg IV
Term
Pepcid
Definition
20 mg IV
Term
Zantac
Definition
50 mg IV
Term
Norepinephrine
Definition

0.05 mcg/kg

 

Helps SVR 

Term
Bronchodilators
Definition

B-agonists

 

Albuterol, Terbutaline, Ipratropium 

Term

Hydrocortisone

 

(Solucortef)

Definition
0.25-1 g
Term

Methylprednisone 

 

(Solumedrol) 

Definition
1-2 g
Term
Sodium Bicarbonate
Definition

0.5-1 mEq/kg 

 

May repeat q 5 min

 

Acidosis reduces effect of epi

Term
Refractory HOTN in Anaphylaxis
Definition
Vasopressin: gtt @ 0.01 units/min
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