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conferenceseries
.com
Volume 7, Issue 7 (Suppl)
J Gastrointest Dig Syst
ISSN: 2161-069X JGDS, an open access journal
Gastroenterologists 2017
December 14-15, 2017
December 14-15, 2017 Dubai, UAE
11
th
World
Gastroenterologists Summit
Dual effect of phenylephrine to improve coronary perfusion during anaphylaxis management
Joseph S Tobias, Elizabeth Richards and Chu Woon Ng
Bundaberg Base Hospital, University of Queensland, Australia
A
drenaline, the drug of choice in anaphylaxis may produce side effects like tachycardia resulting in impaired coronary
perfusion in the setting of severe hypotension. In this situation, Phenylephrine was used to improve coronary perfusion
by increasing coronary flow time from reflex bradycardia and an increase in coronary perfusion pressure resulting from an
overall increase in systemic blood pressure. We describe a situation where at the end of an elective high anterior resection
for colovesical fistula, immediately after administering reversal agents (neostigmine and glycopyrrolate); there was severe
hypotension with systolic blood pressure of 40 mmHg unresponsive to ephedrine and metaraminol. Adrenaline boluses
resulted in tachycardia with marked ST segment elevation and slight increase in blood pressure. Intravenous Phenylephrine
100 mcg bolus was given, repeated twice over a period of 15 minutes which reduced the heart rate from 130 to 100 beats per
minute as well as increased the blood pressure with ST segment returning to baseline. ANZAAG guidelines were followed
to maximize management and team efficiency during and after the crisis and resulted in an uneventful recovery. A 10-fold
increase in serum tryptase confirmed anaphylaxis. Anaphylaxis to reversal agents (neostigmine and glycopyrrolate) is rare and
in this situation, it was complicated by ECG evidence of tachycardia induced ST segment elevation after administration of 2
doses of 100 mcg increments of adrenaline with only small increase in blood pressure. Phenylephrine improved the myocardial
perfusion and blood pressure. We recommend that Phenylephrine should be considered in the presence of adrenaline induced
tachycardia to improve myocardial perfusion during anaphylaxis management.
Biography
Joseph S Tobias, Senior Lecturer in Department of Anaesthesia, Bundaberg Hospital, University of Queensland, Australia
JTobias@doctors.org.ukJoseph S Tobias et al., J Gastrointest Dig Syst 2017, 7:7 (Suppl)
DOI: 10.4172/2161-069X-C1-062