Question

Kelly, a 45-year old female patient, is undergoing a breast biopsy. The surgeon has just injected the incision site with 1% xylocaine. After a few minutes, the patient reports that she feels an overall itching sensation, and the anesthesia care provider notes that she has broken out into hives. Seconds later, she is s having trouble breathing and has become slightly hypotensive and tachycardic.

1. Based on these signs and symptoms, what is Kelly experiencing?

2. What is the surgical team’s first priority?

3. What medication will be given to Kelly first, and what are the actions of that medication?

4. What medication is given to slow the chain of events that caused the reaction to occur?

Answer 1

Ans1)The symptoms shown by kelly are itching sensation, breathlessness, hypotension(low blood pressure) ,tachycardia indicates that She may be suffering from anaesthetic drug (1%xylocaine ) allergy ie, anaphylatic reaction towards administered drug.

Ans2) The surgical team's first priority must be to stop the administeration of suspected drug, call for help and provide airway support and administer oxygen 100%  to pateint immediately. If required,  then intubate the trachea and ventilate lungs with oxygen supply.

As Kelly experiencing hypotension so laid down her in flat position with her legs in elevated position.

Ans3)Epinephrine or adrenaline is administered immediately to patients either intramuscularly in the dosage of 500ug over a minute or intravenously (dosage:50-100ug ). As pateint suffering from hypotension so multiple doses of adrenaline are required so best is to start intravenous infusion of adrenaline .

Epinephrine has alpha agonist activity so it reverse the vasodialation ,causes a positive inotropic action, and prevents or decrease the release of mediators of inflammation ie, histamine and leukotriens.

Alongwith epinephrine also administer fluid therapy ie,  0.9% saline solution intravenously at high rate.
Ans4) Secondary treatment involves the intravenously administeration of antihistamines drugs such as chlorpheniramine (dosage:10-20 mg),corticosteroids such hydrocortisone (dosage:100-500 mg ) and bronchiodialators to slow down the events that causes the hypersensitivity reactions .