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Safe Anesthesia for Every Child

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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