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Anaphylaxis during cardiac surgery: implications for clinicians.

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Levy, JH; Adkinson, NF
Published in: Anesth Analg
February 2008

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.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 2008

Volume

106

Issue

2

Start / End Page

392 / 403

Location

United States

Related Subject Headings

  • Practice Guidelines as Topic
  • Physicians
  • Intraoperative Complications
  • Humans
  • Environmental Exposure
  • Cardiac Surgical Procedures
  • Anesthesiology
  • Anaphylaxis
  • 3202 Clinical sciences
  • 1109 Neurosciences
 

Citation

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Levy, J. H., & Adkinson, N. F. (2008). Anaphylaxis during cardiac surgery: implications for clinicians. Anesth Analg. United States. https://doi.org/10.1213/ane.0b013e3181602e0d
Levy, Jerrold H., and N Franklin Adkinson. “Anaphylaxis during cardiac surgery: implications for clinicians.Anesth Analg, February 2008. https://doi.org/10.1213/ane.0b013e3181602e0d.
Levy JH, Adkinson NF. Anaphylaxis during cardiac surgery: implications for clinicians. Vol. 106, Anesth Analg. 2008. p. 392–403.
Levy, Jerrold H., and N. Franklin Adkinson. “Anaphylaxis during cardiac surgery: implications for clinicians.Anesth Analg, vol. 106, no. 2, Feb. 2008, pp. 392–403. Pubmed, doi:10.1213/ane.0b013e3181602e0d.
Levy JH, Adkinson NF. Anaphylaxis during cardiac surgery: implications for clinicians. Anesth Analg. 2008. p. 392–403.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 2008

Volume

106

Issue

2

Start / End Page

392 / 403

Location

United States

Related Subject Headings

  • Practice Guidelines as Topic
  • Physicians
  • Intraoperative Complications
  • Humans
  • Environmental Exposure
  • Cardiac Surgical Procedures
  • Anesthesiology
  • Anaphylaxis
  • 3202 Clinical sciences
  • 1109 Neurosciences