The immune system begins to develop at what age?
6 weeks of age.
What Functions does the immune system serve?
Support
Protect
Vitalize functions
maintain homeostasis
What is the Innate immune system?
Primary defense again pathogens.
Examples:
Integument: skin prohibits invasion of organisms
Phagocytosis: destruction of foreign organisms
Killer T cells: destroy virus-infected cells.
Passive Immunity
Antibodies (activated T cells) given to provide short-term immunity.
Acquired (Active) Immunity
Immunity obtained either from the development of antibodies in response to exposure to an antigen, as from vaccination or an attack of an infectious disease.
What are the 2 branches of Acquired Immunity?
- Humoral Branch: B lymphocytes, originate in bone marrow and plasma cells
- Cell Mediated Branch: T lymphocytes formed by the thymus.
What changes happens at the tissue level during an inflammatory response?
- Localized vasodilation
- increased blood flow
- increased capillary permeability
- extravasation of plasma proteins
- chemotactic movement of leukocytes to site of injury
Anaphylaxis is:
- IgE mediated
- Immediate systemic hypersensitivity
- Antibodies attach to mast cells and basophils releasing histamines and other inflammatory mediators.
Hives, swelling, stridor, N/V, hypotension, urticaria.
Anaphylactoid reaction is:
- NOT IgE mediated
- same symptoms as anaphylaxis, treat the same.
Type I Hypersensitivity:
Anaphylaxis
Type II Hypersensitivity:
- Antibodies specific to antigens attach to cell surface.
- Cytotoxic (aoutimmune hemolytic anemia or transfusion reaction)
Type III Hypersensitivity:
Immune complex disease
- antibodies bind to antigens and release enzymes that cause tissue damage.
ex. Systemic Lupus Erythromatosus, Rheumatoid arthritis, glomrulonephritis
Type IV Hypersensitivity:
Delayed sensitivity, cell mediated.
-ex. contact dermatitis, graft rejection.
What are the 4 the most common drugs (in order of most to least common) to cause anaphylaxis?
- Muscle relaxants (60%): Rocuronium
- Latex (15%)
- Antibiotics (5-10%)
- Opioids (<5%): demerol and morphine
Treatment for anaphylaxis:
EPINEPHRINE:
Adults: 100-500mcg subQ or IM may repeat q 10-15 minutes or 50-100mcg IV
Children: 10mcg/kg up to 500mcg q 15 x 2, then q 4 hours.
DIPHENHYDRAMINE: 1-2 mg/kg or 25-50mg IV for adults
H1 and H2 blockers.
steroids questionable.
How is at high risk for Latex allergy?
- Health care workers, neural tube defects, multiple surgeries, spina bifida, genitourinary defects
- Cross-sensitivity to tropical fruits, bananas, kiwi, mangos, chestnuts. (If has a known allergy to any of these).
- usually manifests at a Type I anaphylactic or Type IV dermatitis.
Antiretrovirals used to treat HIV/AIDS interact how with CYP450 system?
They are INDUCERS. (they accelerate drug metabolism)
The most common source of accidental HIV exposure of health care workers?
Recapping of needles, more specifically open bore needles.
DO NOT RECAP NEEDLES, and dispose of sharps properly.
What is Systemic Lupus Erythmatosus (SLE)?
Chronic inflammatory disease in which the immune system attacks it’s own tissues by producing antinuclear antibodies.
What organ systems are commonly effected by SLE?
- Renal disease in >50% of people
- Pericardial effusion in >50%
characterized by polyarthritis, dermatitis, malar rash on face
How is SLE treated?
- corticosteroids
- antimalarial drugs
- immunosuppressants
What exacerbates SLE?
- infection
- pregnancy
- surgical stress
- medications (over 80): Procainamide, hydralazine, captopril, enalapril, isoniazid, methyldopa, d-penicillamine.
What are some anesthetic considerations for SLE patients?
- rigidity of laryngeal cartilage from cricoarytenoid arthritis
- restrictive airway disease (smaller tidal volumes)
- prone to PE, pulmonary HTN, pneumonitis, alveolar hemorrhage.
- RLN palsy
- Cyclophoosamine, inhibits plasma cholinesterase, may lead to longer duration of Ester anesthetics and Succinylcholine
What is Scleroderma?
Collagen vascular disease:
-Inflammation, vascular sclerosis, fibrosis of skin and organs
