Obstetrics and Gynecology International / 2009 / Article / Tab 2

Case Report

Severe Anaphylaxis to Volplex, a Colloid Solution during Cesarean Section: A Case Report and Review

Table 2

Treatment of anaphylaxis [21].

(1) Stop administration of the drug(s) likely to have caused the reaction.
(2) First line of treatment includes restoration of blood pressure by making the patient lie flat, raising the foot end and lateral tilt of the patient if occurs antepartum.
(3) Maitain airway: give 100% oxygen.
(4) Adrenaline is given intramuscularly 0.5–1.0 mg 0.5–1 mL adrenaline injection 1 in 1000 . This can be repeated every 10 minutes until improvement occurs. If hemodyanamic instability persists, a continuous drip may be needed. One mg of epinephrine is diluted in 250 mL of saline, starts at 15 mL/hr (1 g /mt), and titrated according to clinical response.
(5) Administer crystalloid or colloid for rapid intravascular volume expansion. If colloid has been given prior to the reaction, change to crystalloid since the causative agent might have been the colloid.

Secondary therapy

(1) Antihistamine, for example, Chlorphenaramine over 1 minute 10–20 mg diluted in a syringe with normal saline or water given slowly intravenously.
(2) Corticosteroids (100–500 mg Hydrocortisone IV) is of use in severely affected patients.
(3) Bronchodialators may be required for persistent bronchospasm.
(4) Prolonged monitoring in the Intensive care unit.

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