How is anaphylaxis managed in the perioperative setting?

• A. Immediate recognition; stop suspected agent; administer intramuscular epinephrine; secure airway; give IV fluids; adjuncts as needed; call for help
• B. Stop suspected agent
• C. Give IV fluids only
• D. Observe and hope symptoms resolve

Answer: (A)

Anaphylaxis in the operating room is a medical emergency that requires rapid recognition and simultaneous management of airway, breathing, and circulation. The best approach is to act immediately: stop the suspected trigger, give epinephrine by the intramuscular route to rapidly reverse the dominant effects of the reaction—vasodilation, increased capillary permeability, and bronchoconstriction—while securing the airway and delivering 100% oxygen. At the same time, start IV fluids to support blood pressure and perfusion, since hypotension can progress quickly. Adjunct medications such as antihistamines and corticosteroids can help with the allergic response, but they do not replace the critical need for epinephrine and airway/circulatory support. Throughout, call for help and be prepared to escalate (for example, by advancing airway management or using an IV epinephrine infusion if needed) as the situation evolves. This comprehensive, prompt approach is what stabilizes the patient and prevents deterioration.