When does your immune system begin to develop?
approx. 6 wks
What are some of the functions of the immune system?
What are two types of Specific Immunity?
Innate immunity has three ways of prohibiting or destroying bacteria. What are they?
What are the 2 branches of Acquired (adaptive) Immunity?
- *Humoral (B-lymphocytes produced in bone marrow and plasma cells)
- *Cell Mediated (T-lymphocytes produced in Thymus)
How is Acquired Immunity developed?
Resistance is developed after entrance of foreign pathogens into the body. T-lymphocytes produce antibodies and B-lymphocytes produce Immunoglobulins (Ig)
What are two ways of developing Non-specific immunity?
- Vaccinations (can produce acquired immunity)
- Passive immunity (antibodies given to provide protection; breast feeding)
How is an allergic reaction started?
Foreign pathogen stimulates antibodies to attach to mast cells and basophils –> release of histamines
What is Anaphylaxis?
A systemic hypersensitivity that is IgE mediated.
Causes release of tissue mast cells and peripheral blood basophils.
Is anaphylaxis rapid or delayed in onset?
Rapid - can occur in seconds to 30 mins.
What is hypotension during anaphylaxis attributed to?
Increased capillary permeability which can cause a fluid shift up to 50%.
What is the difference between anaphylactic and anaphylactoid reactions?
Anaphylactoid reactions are Non-IgE mediated responses.
Looks the same as a anaphylactic reaction.
*May take greater amount of exposure to produce a reaction than anaphylactic
What are the 4 groups of hypersensitivity?
Type I. Anaphylaxis
Type II. autoimmune hemolytic anemia
Type III. Immune complex disease (SLE, Rheumatoid, Glomerulonephritis)
Type IV. Delayed (contact dermatitis, graft rejection)
Which drugs are the most commonly associated with allergic reactions?
- Muscle relaxants (60%)
- Rocuronium in females r/t cosmetics
- Latex 15%
- Antibiotics (5-10%)
- Opioids (<5%)
How would you treat a non-life threatening allergic reaction?
- Adult 100-500 mcg SQ or IM q 10-15min
- Child 10mcg/kg (500 max) q 15min x 2 then q 4 hr
- Benadryl 1-2mg/kg or 25-50mg IV
- Corticosteroid (questionable)
How would you treat a life threatening allergic reaction?
- Epi 50-100 mcg IV
- Cardiovascular support, CPR, pressors, fluids
- 100% O2
- H1 antihistamine (Benadryl)
- H2 Blocker (Pepcid, Zantac)
What are some common food allergies a person may have if they also have a latex allergy?
Bananas, Kiwi, Mangos
What are the types of allergic reactions a person could have to latex?
Type I (anaphylaxis) or Type IV (Dermatitis)
HIV/AIDS pts - _____% can have an abnormal EKG
_______% can have pericardial effusions
50% - EKG
25% - Pericardial effusion
What are two major concerns with HIV/AIDS?
- Infection to the pt
- Infection of the staff
What types of infections are HIV/AIDS pt’s most susceptible?
Bacterial, Viral, Protozoal, Fungal
**PNUEMOCYSTIS CARINII or PC pneumonia (fungal pneumonia) is most common cause of AIDS related death
What exposure places a healthcare worker at greatest risk of getting HIV/AIDS?
- needle stick with open bore needle
DO NOT RECAP THESE NEEDLES
-small risk for infection after splash to mucous membranes
what should you do after exposure to fluids from HIV/AIDS pts?
- Wash and clean the area
- Get immediate baseline test (you & pt)
- Empirical treatment with 2 or more antiretrovirals (within 1-2 hrs or within 1-2 wks)
- Seroconversion in 6-12 wks
- Periodic testing for 6 months
What are some common presenting symptoms of SLE?
- polyarthritis and dermatitis
- Malar rash (1/3 of pts)
- Renal disease (>50%)
- *Renal disease is most common cause of death
What does SLE place these pts at high neurological risk for?
Seizures, stroke, dementia, neuropathy, psychosis
What does SLE place these pts at high cardiac risk for?
pericardial effusion (>50%) **tamponade is rare
What are some common meds used for treatment of SLE?
What can cause exacerbation of symptoms in SLE?
Drugs - Over 80 different ones
What kind of pulmonary issues can a pt with SLE have that would give us the biggest anesthesia concerns?
Prone to Pleural effusion Pneumonitis Alveolar hemorrhage Pulmonary HTN ***end result is a restrictive defect
What kind of airway changes would lead to anesthesia concern for SLE pts?
recurrent laryngeal nerve palsy
What might a pt with SLE need perioperatively to help prevent low blood pressure?
One of the medications a pt with SLE might be taking, Cyclophosphamide, inhibits plasma cholinesterase. What anesthetic concerns would this cause?
Inhibits plasma cholinesterase -Could prolong the action of Ester LA and Succs
For HIV/AIDS pts, some meds can induce Cytochrome P450 system. What kind of anesthetic implications could this have?
It speeds up metabolism or other meds that require the CyP450 system could have a shorter duration of action.
Anesthetic implications for scleroderma
- May require fiber optic intubation
- Bleeding with airway manipulation
- Chronic HTN (therefore have hypovolemia)
- GERD due to hypotonesis of LES
- Pulmonary HTN (avoid acidosis, hypoxemia)
What anesthesia technique may be preferred in Scleroderma pts?
Regional - offers advantage of peripheral vasodilation and post-op pain control
What are some medication considerations when taking care of pts with RA?
- may need steroid supplementation during surgery
- could be taking Cyclophosphamide (plasma cholinesterase inhibitor)
- platelet disfunction due to NSAID use
What are some airway problems with pts with RA?
Cervical joints could be affected - neck extension may be limited. Could cause Atlantoaxial subluxation
- small mouth opening due to temporomandibular joint issues
- generalized swelling and edema to laryngeal area
- Consider fiberoptic or glidescope intubation