Table 3
SSAI Guideline on treatment of anaphylactic reactions during anaesthesia.
| Primary treatment | Dosage |
| Stop administration of suspected substance | |
| Call for help and inform the surgeon | |
| Trendelenburg position | |
| Maintain airway and give oxygen | FiO2 1.0 |
| Adrenaline | Adults: |
| Use diluted adrenaline i.v. maximum concentration 0.1 mg/ml | Mild to moderate reaction: 0.01–0.05 mg i.v. |
| Circulatory collapse: 0.1–1.0 mg i.v. | |
| i.v. infusion starting at: 0.05–0.1 μg/kg/min | |
| Without i.v. access: 0.5–0.8 mg i.m. | |
| Titrate dose to response | Children: |
| If large doses are needed, use i.v. infusion | Mild to moderate reaction: 0.001–0.005 mg/kg i.v. |
| Circulatory collapse: 0.01 mg/kg i.v. | |
| Without i.v. access: 0.005–0.01 mg/kg i.m. | |
| Fluid therapy | Adults: |
| NaCl 9 mg/ml, Ringer’s acetate or colloids | 20 ml/kg, more may be needed |
| Children: | |
| 20 ml/kg, more may be needed | |
| Secondary treatment | |
| Corticosteroids | Adults: |
| Hydrocortisone 250 mg i.v. or Methylprednisolone 80 mg i.v. | |
| Children: | |
| Hydrocortisone 50–100 mg i.v. or Methylprednisolone 2 mg/kg i.v. | |
| Antihistamines | Adults: |
| H1 antagonist, e.g. Clemastin 2 mg or Deksklorfeniramin 10 mg or Promethazin 50 mg given i.v. | |
| H2 antagonist: consider Ranitidine 50 mg i.v. | |
| Children: | |
| e.g. Clemastin 0.0125–0.025 mg/kg or Deksklorfeniramin 5 mg or Promethazin 0.3–1.0 mg/kg given i.v./i.m. | |
| Nebulised β2-agonist may be used for symptomatic treatment of bronchospasm, but is not first-line treatment | |
| Lack of response to adrenaline | |
| Noradrenaline | i.v. infusion starting at: 0.05–0.1 μg/kg/min |
| Vasopressin | Increments of 2–10 IU i.v. until response |
| Glucagon | Increments of 1–2 mg i.v. until response |
| (If lack of response to large doses of adrenaline in patients on β-blockers) | |
| i.m., intramuscularly; i.v., intravenously. | |