How should an intraoperative anaphylactic reaction be managed?

• A. Ignore the reaction.
• B. Stop triggering agent, call for help, secure airway, administer epinephrine if indicated, provide 100% O2, monitor vitals.
• C. Move patient to postoperative care before addressing reaction.
• D. Administer only IV fluids.

Answer: (B)

An intraoperative anaphylaxis requires immediate, decisive action to stop progression and support life. The best approach is to stop the triggering agent if possible, call for help from the anesthesia and surgical teams, secure the airway because airway edema and bronchospasm can rapidly compromise breathing, provide 100% oxygen to maximize oxygen delivery, and administer epinephrine promptly if there are signs of significant reaction such as hypotension or bronchospasm. Epinephrine addresses the key pathophysiology by reversing vasodilation and capillary leak, reducing airway edema, and improving blood pressure and perfusion. After these essentials, continue close monitoring and support with IV fluids and vasopressors as needed, along with adjuncts like antihistamines or bronchodilators as appropriate. Ignoring the reaction, delaying treatment, or relying on fluids alone would fail to rapidly counteract the life-threatening processes occurring during anaphylaxis.