Anaesthesia (Small and equine) Flashcards
(77 cards)
1
Q
ASA statuses?
A
ASA 1: normal healthy animal
ASA 2: mild systemic disease
ASA 3: moderate systemic disease
ASA 4: severe systemic disease, constant life threat
ASA 5: moribund, not expected to survive following 24h
2
Q
Aims of anaesthesia?
A
Unconsciousness
Analgesia
Muscle relaxation
3
Q
Which anaesthetic drugs do/do not achieve analgesia, unconsciousness and muscle relaxation? (ACP, benzo, a2, opioids, barb, ket, propofol, inhalation, N2O, local)
A
Analgesics: - A2 agonists - Opioids - Ketamine - N20 - local Sedatives: - ACP - A2 agonists - Opioids Loss of consciousness: - Barbiturates - Ketamine - Propofol - Inhalationals Muscle relaxation: - ACP - Benzodiazepines - A2 agonists - Barbiturates - Propofol - Inhalationals
4
Q
What is balanced anaesthesia?
A
Using safe doses of 2+ agents or methods to:
- Reduce dose of each
- Reduce side effects
- Optimise analgesia
5
Q
Advantages and disadvantages of injectable induction of anaesthesia?
A
Advs:
- Not much equipment needed
- Generally rapid and smooth
- No enviro pollution
Disadvs:
- Once delivered, retrieval impossible
- Must have accurate weight (good estimate in LA)
- CV and resp depression
- Accidental self administration
6
Q
Ideal induction agent?
A
Easy to put into solution and stable with a long shelf life Cheap Not painful on injection Rapid onset Smooth induction and recovery Rapid redistribution, metabolism and clearance No active metabolites Safe No side effects Analgesia Muscle relaxation
7
Q
Propofol - Side effects? Benefits over alfaxolone?
A
Vasodilation with no compensatory increase in HR (-> hypotension -> reduced blood flow to vital organs)
Post-induction apnoea (so should pre-oxygenate for 5 mins)
Cats:
- Repeated doses are cumulative (takes couple of days to remove from body)
- Potential for Heinz body anaemia (due to oxidative damage to RBCs)
8
Q
Alfaxalone - Side effects? Benefits over propofol?
A
Vasodilation with compensatory increase in heart rate (so CO maintained better than propofol)
Post-induction apnoea (but less than propofol)
Not cumulative in cats (can use multiple times in short period)
Can give IM and IV
More twitching than propofol (avoid in seizure patients as can’t tell if seizing or twitching)
9
Q
Ketamine - Features? Side effects?
A
Excellent analgesia
Induction agent
Increase in sympathetic tone - vasoconstriction
Direct negative inotrope
(So CO maintained due to opposite effects of vasoconstriction and negative inotropy)
Often get post-induction apnoea
Can give IM and IV
Causes muscle rigidity - ideally use with a drug that gives muscle relaxation
Propofol/alfaxolone and ketamine often used for co-induction - uses analgesia of ketamine and reduce doses to reduce side effects
Dogs and cats will often salivate excessively
Often will keep cranial nerve reflexes so hard to tell how asleep
Good in horses as small volume needed, takes about 2 mins to work, often go down nicely
10
Q
Etomidine - What is it? When used?
A
Induction agent Only one with virtually no CV effects Good for animals with CV compromise Stops adrenal glands working Not really used in practice
11
Q
Thiopental - What is it? When used?
A
Induction agent Stopped using in UK Used in equine Only drug able to use at sensible volume when horse is too light on table CV effects - arrhythmias etc
12
Q
Advantages and disadvantages of inhalation agents for induction of anaesthesia?
A
Advs: - Doesn't require IV access Disadvs: - Prolonged induction time - Likely to cause distress - Airway irritation - Enviro pollution - Requires tight fitting mask or chamber - Increased risk of death compared to injectable
Don’t use unless have to
Sevoflurane if have to - smells nicer, quicker induction, reduced chance of dying
13
Q
Why monitor anaesthesia?
A
Maintain physiology Maintain adequate anaesthetic depth Prevent pain Safety Legal implications
14
Q
What reflexes/other visual things can be monitored during anaesthesia? How do they change with depth?
A
Palpebral reflex: brisk/spontaneous -> sluggish -> absent (check both as becomes refractory)
Anal: brisk -> sluggish -> absent tone
(Corneal)
Eye position: central -> ventral -> central
Pupil: dilated -> constricted -> dilated
Lacrimation: decreases as deepens
Changes in autonomic tone: sweating
Muscle tone: tension in tendon of sternocephalicus, jaw tone
Movement = either very light or about to die
15
Q
CV monitoring under anaesthesia?
A
HR/pulse:
- Dogs: 50-120
- Cats: 60-140
- Horses: 24-40
Central vs peripheral artery palpation gives indication of perfusion
Mucous membrane colour indicates oxygenation and perfusion
CRT depends on blood volume and capillary tone:
- <1 second = poor perfusion or hypovolaemia
- >2 seconds = maldistributive shock
16
Q
Respiratory monitoring under anaesthesia?
A
Normal rate: - Dog and cats: 10-30 - Horses: 8-10 Bradypnoea: - Too deep - Hypocapnia - Isoflurane, propofol, fentanyl - Alkalosis Tachypnoea: - Too light - Hypoxia, hypercapnia - Methadone - Poor analgesia - Acidosis Watch reservoir bag movement - % inhaled Mucous membrane colour - cyanosis = severe hyperaemia
17
Q
Normal blood pressure under anaesthesia?
A
Systolic: 80-130mmHg
Diastolic: 40-60mmHg
Mean: >60mmHg
18
Q
Types of blood pressure monitoring under anaesthesia? Advs and disadvantages?
A
Non invasive BP:
- Oscillometric or Doppler
- Intermittent readings or SBP or MAP
- No risk of infection
- Need correctly fitting cuffs (easy to get inaccurate values)
Invasive BP
- Continuous readings of SBP, DBP and MAP
- Invasive/risk of infection
- Allows arterial blood sampling (blood gases)
- More expensive equipment
19
Q
What is pulse oximetry? What does it tell you? Normal values? Limitations?
A
Measures % saturation of oxygen of Haemoglobin (SpO2) Normal: 97-99% Measures pulse Indirect indication of perfusion (plesthysmograph) Limitations: - Hypotension/vasoconstriction - Affected by bright light - Non pigmented mucosa - Movement sensitive - Probe may blanch capillary bed - 'Beeps' may be over-interpreted
20
Q
What is capnography? What are normal values? What does it tell you? Parts of curve?
A
Measures end tidal CO2 (EtCO2) Normal: 35-45mmHg >60mmHg = hypoventilation <35mmHg = hyperventilation Other uses: - correct placement of ETT - Confirms pulmonary circulation (CCPR) - Indicates problems e.g. with breathing system Curve: - Respiratory baseline (should be 0) - Expiratory upstroke - Alveolar plateau - EtCO2 - Inspiratory downstroke
21
Q
What is sedation?
A
Mental calming
Sleepiness and disinterest in environment
Decreases responsiveness to a stimuli
Animals can still be aroused
22
Q
Why use a premedication?
A
Relieves anxiety Smooths induction, maintenance and recovery phases Anaesthetic sparing effects Pre-emptive analgesia Reduces muscle tone
23
Q
Reasons to use sedation?
A
Premedication
Chemical restraint
May provide analgesia
Reduce muscle tone
24
Q
Ideal premedication?
A
Reduce fear and anxiety Easy to administer Quick onset Reasonable duration of action Antagonisable Predictable and reliable Safe Effective in many species Minimal resp, CV and other side effects Analgesia Muscle relaxation Amnesia
25
Ideal sedative?
```
High therapeutic index
Reliable and predictable
Rapid onset of action
Well absorbed by all routes
Non irritant to tissues
Non painful on injection
No side effects
Practical volume to administer
Analgesia and some muscle relaxation
Antagonisable
```
26
Acepromazine - Type of drug? Effects? Side effects? Onset? Duration?
Phenothiazine
Mental calming die to dopamine antagonism
Commonly used as a premedication, often with opioids
Unpredictable sedative
No analgesia
Many other sites of action leads to side effects
Potentiates CNS depressant effects of other sedative and anaesthetic agents
Vasodilation, hypotension, bradycardia (-> CV collapse -> syncope, especially in brachycephalic dogs) - care in CV compromised patients
Will cause pharyngeal muscle relaxation (problem in brachycephalic dogs)
Anti-emetic
Anti-histaminic
Avoid in very excited animals
Can cause excitation at high doses/overdoses
Beware in paediatric patients
Avoid in breeding stallions
Hypothermia
Not reversible
Onset: 30-40 mins
Duration: 4-6 hours
27
Azaperone - Type of drug? How does it work? When used? Side effects?
Butyrophenones
Used in pigs
Antidopaminergic and anti-adrenergic effects in reticular activating system of CNS
Avoid large doses in boars - penile prolapse
Care in brachycephalic pigs
Hypothermia
28
A2 agonists - Examples? How it works? Advs? Side effects? Care?
Examples:
- Xylazine
- Detomidine
- Medetomidine
- Dexmedetomidine
- Romifidine
How it works:
- Suppression of activity in reticular activating system
- A2 agonism in the locus coeruleus in brainstem
Advs:
- Analgesia (of shorter duration than the sedation)
- Muscle relaxation
- Reversible: atipamezole
- All can be given IV, IM or SC
- Some can be given transmucosally/oromucosally
- Predictable, dose dependent sedation
- Sedation may be profound
- Anaesthetic sparing effect
Side effects:
- Hormonal effects - diuresis, hyperglycaemia
- GI effects
- Sweating
- Initial hypertension and peripheral vasoconstriction -> reflex bradycardia -> relaxation of peripheral vascular tone -> eventual state of peripheral vasculature and BP stays fairly close to normal
- Significantly reduces CO
- Sinus arrhythmia, SA block and AV blocks possible
- High doses can lead to hyperaemia
- Can be absorbed across mucous membranes
- Suppression of thermoregulation
Care in CV compromised patients!
Care in sick/debilitated patients!
Care if diabetes mellitus!
Care if laryngeal dysfunction!
29
Benzodiazepines - What do they do? How do they work? Effects? Side effects? Examples?
Unreliable sedation in healthy animals
Useful in 'at risk' patients
GABA-specific benzodiazepine binding sites - brain and spinal cord
Central muscle relaxation
No analgesia
Anticonvulsant
Side effects:
- Minimal CVS depression
- Midazolam will cause greater CV depression than diazepam at higher doses
- Minimal respiratory depression
- Enhances the depression caused by other drugs
- Binds to some plastics (giving sets etc)
- Postural muscle weakness
- Care if hepatic disease
Can be reversed by flumazenil or surmazenil
Examples:
- Midazolam
- Diazepam
(None licensed)
30
Opioids - What do they do? Effects? Side effects? Examples?
```
Potent, efficacious analgesics
Bind to opioid receptors
Also effects on resp, GIT and CV systems
Can cause sedation alone in severely compromised animals where low level sedation is required
But often sedation is poor
Used with other sedatives to improve the quality of sedation
Can be antagonised
Examples:
- Pethidine
- Methadone
- Morphine
- Fentanyl
- Buprenorphine
- Butorphanol
```
31
Advantages and disadvantages of inhalation agents for maintenance of anaesthesia?
```
Also delivers oxygen
Can ventilate fairly easily if required
Easy to alter anaesthetic level
Easy to remove from the animal
Low running costs
```
Expensive equipment
Cannot deliver without specialist equipment
Must have an airway
32
What can be used for muscle relaxation on induction?
A2 agonist
GGE
Benzodiazepine
33
Advantages and disadvantages of intravenous agents for maintenance of anaesthesia?
No need for specialist equipment
Bolus or TIVA
Cumulative effect - prolonged recovery, slower changes in depth
Doesn't deliver oxygen unless supplemented
Once given, can't be easily removed
Drugs can be expensive
34
Ideal maintenance agent?
```
No side effects or negative interactions with other drugs
Safe in every species
Rapid control of depth
Cheap
Not an environmental contaminant
Antagonisable
Easy to use
Minimal/no metabolism
Muscle relaxation
Analgesia
Safe to use
Pleasant smell for inhalation/non painful on injection
Can administer by variety of routes
```
35
What is MAC? What is it affected by?
Minimal alveolar concentration
= alveolar concentration at which 50% of patients will respond to a standard noxious stimulus
Expressed as a %
Allows comparison of potency (ie how much we need for desired effect)
Majority of animals should be adequately anaesthetised at 1.2-1.5 x MAC
If need more than this then think why? - not enough analgesia, leak (more drugs = more side effects)
Affected by:
- Species
- Age
- Hypoxia
- Profound hypotension
- Temperature
- Circulating catecholamines
- Pregnancy
- Other drugs
36
How are inhalation agents delivered during anaesthesia?
```
Starts as liquid
Put into vaporiser
Get liquid and vapour above this liquid
Oxygen flows over and picks up the vapour
Delivered via breathing system to animal
```
37
Bolus v constant infusions of intravenous anaesthetic agents?
Bolus:
- Not ideal as have more at risk and too awake periods (depth not constant, going up and down)
Constant infusion:
- At desired depth more consistently
38
Species differences with inhalation agents for anaesthesia maintenance?
Horses more susceptible to the respiratory depressant effects
Nitrous oxide will move into gas filled spaces - can make colic/pneumothorax etc worse, care in ruminants
Costs of TIVS with propofol and alfaxolone makes them less likely to be used in larger animals
Propofol and cats!
39
Factors influencing choice of maintenance agent?
```
Licensing
Food producing
Species
Equipment level
Duration of anaesthesia
Need for secure airway
Need for oxygen
Need for analgesia
Cost
Availability
Familiarity
Health status
In clinic or field
```
40
Body compartments?
60% BW is water in adult
40% ICF: 20% ECF
15% ISF: 5% plasma
41
What is the circulating volume in different species?
Circulating volume = intravascular volume + volume of cells
Dogs and horses: 8-9% BW = 80-90ml/kg
Cats, rabbits, sheep and cows: 6-7% BW = 60-70ml/kg
(If PCV is 0.4L/L, then circulating volume is 5% + 4% = 9%)
42
Where are Na+, Cl-, K+ and protein found: ECF, plasma, ICF?
ECF: Na+ and Cl-
Plasma: Na+, Cl-, colloidal proteins
ICF: K+ and proteins
43
Maintenance fluid requirement?
2-3ml/kg/hr
| 50-75ml/kg/day
44
Types of fluid loss? What happens to PCV and TP?
Whole blood loss (haemorrhage):
- Lose water, colloidal particles, red cells and electrolytes
- Lost exclusively from the intravascular compartment
- PCV/TP not altered in short term
- Replace with blood, or colloids and crystalloids
ECF loss (D+, V+, diuresis):
- Lose Na+, Cl- and water
- Lost from ISF and intravascular compartments
- Osmotic potential of the remaining ECF doesn't change and ICF not affected
- Replace with Hartmann's or normal saline
Protein rich ECF loss (exudates, effusions, PLE, PLN):
- Lose Na+, Cl-, water and proteins
- Lost from ISF and intravascular comparments
- Replace with colloids
Pure water loss (dehydration):
- Lose water
- Lost from all 3 compartments
- Osmotic potentials all increase equally but stay at normal ratios between compartments
- Replace with Aquapharm 18/6
45
ECF volume replacers? What do they do? Examples?
For each litre administered, only 250ml remains in the intravascular space
Hartmann's:
- 131mmol Na+, 5mmol K+, 111mmol Cl-, 29mmol lactate
- Contains 'bicarbonate sparing' lactate ion
Normal saline (0.9%)
- 150mmol Na+, 150mmol Cl-
46
Types of fluids for fluid therapy?
ECF volume replacers - Hartmann's, normal saline
Maintenance solutions/water replacers - Aquapharm 18, Aquapharm 6
Plasma volume expanders - colloids, hypertonic saline
47
Maintenance solutions/water replacers? What do they do? Examples?
Normal fluid losses = hypotonic to ECF and contains more K+
But can't put a solution into the vascular space that is too hypotonic as would cause haemolysis
Low Na+
Aquapharm 18:
- 4% glucose, 0.18% NaCl (with K added)
Aquapharm 6:
- 5% dextrose (with K added for maintenance)
Glucose/dextrose metabolised by RBCs and prevent haemolysis
48
Plasma volume expanders? What do they do? Examples?
Must always be followed by ECF replacers to pay back fluid taken from ISF
Only transient effect
Colloids:
- Large molecules that can't pass through (healthy) vascular endothelium
- So increase the colloidal osmotic pressure of the plasma and 'pull' water in from ISF
Hypertonic saline (7.2% NaCl):
- Draws water in from ISF
- Causes a pulmonary-vagal reflex which leads to haemodynamic effects such as venoconstriction and a bypass of pulmonary circulation
49
Blood/blood products? What do they do? Examples?
Provide circulating volume but not expansion (ie 1L of blood gives 1L of circulating volume increase)
50
Benefits of enteral fluids? Advs over parenteral?
'Feeds the gut'
Natural
No need for sterility
Owner/farmer can do
Parenteral needs sterility, risk of air/thrombus embolism, expensive, veterinary procedure
51
How to monitor fluid therapy?
Urine production/specific gravity
Pulse quality
Skin tent
PCV/TP etc
52
How to decide on an alagesic drug?
```
Type of pain expected
Degree of pain expected
What is available
Ease of administration
Licensing
Safe to use
```
53
What parts of the pain pathway do different analgesics work on?
NSAIDs and opiates: nerve terminal, dorsal horn of spinal cord, brainstem/cerebrum
NMDA antagonists, Calcium channel blockers and tramadol: dorsal horn and brainstem/cerebrum
Local anaesthetics: nerve terminal only
54
NOLANP?
```
NSAIDs
Opioids
Local anaesthetics
A2 agonists
NMDA antagonists
Paracetamol
```
55
NSAIDs: How do they work? Contraindications? Side effects?
Work on COX enzymes
Inhibit prostaglandin release
Don't use if think animal is hypotensive as reduces renal perfusion (less of problem in horses, still use in colic cases)
Long term use - GI upset
56
What affects the onset of action, duration of action and potency of local anaesthetic drug?
```
Onset of action:
- Less alkaline pH = faster onset
Duration of action:
- Increased protein binding = longer duration
- Vasodilation = shorter duration
Potency:
- Increased lipophilicity = increased potency
- Small size = increased potency
```
57
What toxicities do local anaesthetic drugs have?
```
Lidocaine:
- Respiratory depression
- Seizures
Bupivacaine:
- Cardiotoxicity
```
58
Paracetamol: Licensing?
Licensed in dogs in combination with codeine
Can use with NSAIDs or steroids (despite datasheet)
Not cats
59
Which drugs are used for chronic pain?
As for acute, plus:
- Gabapentin
- Amantadine
- Antidepressants
- Green lipped mussel
- Elk velvet antler
- Capsacin
60
What are the main peri-anaesthetic complications?
Hypotension
Hypoventilation/hypoxaemia
Hypothermia
Pain
61
Risk factors for perianaesthetic mortality? Mortality rate in different species?
Pre-existing patholgies
Overweight/underweight
Procedure urgency and duration
Emergency procedures
Dogs: 1 in 600 overall, 1 in 75 ASA 3-5
Cats: 1 in 400 overall, 1 in 70 ASA 3-5
Horses: 1 in 100 non colic, 1 in 20 colic
62
What should blood pressure kept at under anaesthetic? Why?
MAP >60mmHg for perfusion of vital organs (brain, heart, kidneys)
- >70mmHg often wanted in large horses to reduce risk of myopathy
SAP >80mmHg
Hypotension if MAP <60 or SAP <80 -> hypo perfusion of vital organs and extremities -> inadequate delivery of oxygen and removal of waste products
63
Causes of hypotension under anaesthesia?
```
Hypovolaemia:
- Haemorrhage
- Pre-existing fluid deficits
- Fluid loss due to evaporation
- "Third" spacing
- Inadequate intra-op fluids
Vasodilation:
- Anaesthetic drugs
- Severe metabolic or respiratory acidosis
- Endotoxaemia
- Septicaemia
- Anaphylactic reaction
Decreased CO due to arrhythmias:
- Bradycardia
- AV block, AF, VT
Obstruction of venous return:
- Secondary to IPPV
- Pericardial effusion, mediastinal tumours, tension pneumothorax, surgical retraction of organs
```
64
What to do if hypotension under GA?
Check BP device - cuff/transducer position and repeat measurement
Anaesthetic level - lighten?
Fluids - bolus
Positive inotropes - B1 agonist (Dobutamine in horses)
Vasopressors - a1 agonist
Positive chronotropes
65
Consequences of intra-op hypotension?
Poor recovery
Myopathy
Organ injury
66
Causes of bradycardia under GA? Treatment?
```
Drugs - high doses of mu opioids, a2 agonists
High vagal tone
Hypothermia
CNS disease (increased ICP)
Hyperkalaemia
```
Treatment:
- Check if necessary, what's the BP?
- Atipamezole if a2 agonists were used
- Anticholinergics: atropine vs glycopyrrolate
- Treat underlying cause
67
Causes of sinus tachycardia under GA? Consequences? Treatment?
Caused by SNS stimulation:
- Pain
- Inadequate anaesthesia
- Hyperthermia
- Hypotension
- Hypovolaemia
- Hypoxaemia
- Hypercapnia
- Hypoglycaemia
Consequences:
- Decreased diastolic filling and decreased ejection and coronary perfusion time -> myocardial ischaemia
- Greatly reduced CO
Treat underlying cause of SNS stimulation
68
What is hypoxaemia? Measurements?
= Abnormally low O2 content in the systemic arterial blood (PaO2)
Mild: 80-90mmHg
Moderate: 60-80mmHg
Severe: <60mmHg
69
What are the general effects of anaesthesia on respiratory system?
Respiratory centres and chemoreceptors are depressed by GA agents and mu opioid agonists -> reduced ventilatory drive
Depressant effects of anaesthetic drugs on intercostal muscles and diaphragm -> hypoventilation and hypercapnia
Lung volume at end of expiration (FRC) is reduced, esp in dorsal recumbency
When FRC is close or less than closing capacity -> atelectasis develops:
- Gas trapped in alveoli absorbed into circulation
- Big problem in obese patients
Atelectasis also develops as a result of lung compression and surfactant dysfunction
Blood flowing to atelectatic areas is not taking part in gas exchange -> shunt
70
How to recognise hypoxaemia?
Gold standard is arterial blood gas to measure PaO2
Pulse oximetry: SpO2
Visual inspection of MM colour:
- Cyanosis when >5g/dl of deoxyHb in the blood
- Normal Hb is around 15g/dl
- If animal is anaemic with Hb<5g/dl, can never become cyanotic
- Cyanosis is late indicator of hypoxaemia
71
Pulse oximetry:
```
Non invasive method to measure peripheral oxygen saturation (SpO2) of Hb
Affected by:
- vasoconstriction
- movement
- light
Add from rotation notes
```
72
Causes of hypoxaemia under GA?
```
Inadequate O2 supply:
- Empty cyclinder
- Blocked hosing
Airway obstruction:
- Blocked/kinked ETT or respiratory tract (e.g. with blood/mucus)
Profound hypoventilation -> hypercapnia:
- Opioids
- Dorsal recumbency
V/Q mismatch and shunt
Circulatory failure
Poor gas exchange (increased diffusion barrier)
Increased O2 requirements
```
73
What to do if hypoxaemia under GA (e.g. SpO2<90%, PaO2 low on blood gas analysis)?
Check O2 supply and patency of ETT
Give O2/increase inspired O2 if possivle
IPPV to reduce effects of hypoventilation/hypercapnia on promoting hypoxaemia
B2 agonist (salbutamol inhaler in horses, 2 puffs/100kg)
74
Consequences of hypothermia under GA?
CV changes:
- Bradycardia
- Hypotension
- Increased blood loss/coagulopathy
- PCV increases -> blood more viscous which increases myocardial work
Respiratory changes:
- Hypoventilation with CO2 retention (respiratory acidosis)
- Slight left shift of Hb/O2 dissociation curve -> impedes tissue oxygen delivery
- Decreased mucociliary activity -> increased risk of airway obstruction/infection
- Immunosuppression - increased risk of infections
CNS depression:
- MAC reduction so beware of deepening anaesthesia
Post-op:
- Slow recovery (slow metabolism/elimination of drugs)
- Shivering once >34C -> increase metabolic rate, increases oxygen demand, increases cardiopulmonary work
- Delayed wound healing, increased wound infection
75
Signs of anaphylaxis?
```
Hypotension
Tachycardia
Tachypnoea
Arrhythmias
Bronchoconstriction
Sweating, hives (horses)
Facial/periorbital/sublingual/laryngeal oedema
Death
```
76
Difference between anaphylactic and anaphylactoid reactions?
Anaphylactic reaction = IgE mediated, requires previous exposure to the agent
Anaphylactoid reaction = IgE independent, no immune trigger necessary
Both cause rapid degranulation of mast cells -> histamine release, PG, LT
77
Treatment of anaphylaxis?
Antihistamines - chlorphenamine
Corticosteroids
CV support - Iv fluids, epinephrine CRI, O2, CPR
