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Safe Anesthesia for Every Child The Safetots.org initiative addresses the safe conduct of pediatric anesthesia. We promote the rights of the child for high quality care in the right environment

Anaphylaxis (10Cs)

This page is part of the Safetots Crisis SOPs, a framework for prevention and treatment of the most relevant crisis situations in pediatric anaesthesia.

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Summary

  • anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction
  • anaphylaxis is very rare in children but requires swift and effective recognition and treatment

Background

  • severe anaphylactic reactions in children are rare
  • main triggers are antibiotics, colloids, hypnotics, muscle relaxants, intravenous contrast and latex
  • prompt recognition and early treatment is required to avoid morbidity and mortality

Prevention

  • take careful patient history
  • high index of suspicion if severe hypotension and/or bronchospasm occurs
  • knowledge of potential cross-reactivity
  • eliminate potential triggers (latex free environment)
  • ensure availability of effective drug treatments

 

alternative diagnosis: Intestinal eventration syndrome, local anesthetic systemic toxicity

Treatment

  • call for help
  • stop the triggering agent
  • give epinephrine 10 micrograms/kg IM, repeat iv as required
  • give epinephrine IV (1-2-3-5-10 micrograms/kg) titrated according to effect
  • maintain/ establish airway, give high flow oxygen, monitor vital signs
  • consider raising legs/ fluid challenge if hypotension
  • give antihistamines and steroids

Post Care

  • take three timed blood samples for serum tryptase (as soon as possible, 1-2 hours and >24h after event)
  • develop urgent management plan according to clinical needs
  • monitor patient carefully in the postoperative period
  • provide patient letter and letter to family physician
  • arrange referral to allergy clinic

References

  1. Becke K. Allergie und Anaphylaxie in der Kinderanästhesie. Anästh Intensivmed. 2015; 56: 126-34.
  2. Johnston EB, King C, Sloane PA, Cox JW, Youngblood AQ, Lynn Zinkan J, Tofil NM. Pediatric anaphylaxis in the operating room for anesthesia residents: a simulation study. Paediatr Anaesth. 2017; 27: 205-10.
  3. Sommerfield DL, Sommerfield A, Schilling A, Slevin L, Lucas M, von Ungern-Sternberg BS. Allergy alerts – The incidence of parentally reported allergies in children presenting for general anesthesia. Paediatr Anaesth. 2019; 29: 153-160.
  4. Dewachter P, Mouton-Faivre C. [Allergic risk during paediatric anaesthesia]. Ann Fr Anesth Reanim. 2010; 29: 215-26.
  5. Karila C, Brunet-Langot D, Labbez F, Jacqmarcq O, Ponvert C, Paupe J, Scheinmann P, de Blic J. Anaphylaxis during anesthesia: results of a 12-year survey at a French pediatric center. Allergy. 2005; 60: 828-34.
  6. 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; 121: 172-88.

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