Anaphylaxis — Off · Lift · Adrenaline
Perioperative anaphylaxis recognition + first 90 sec
Mnemonic device
OLA
Mapping
O
OFF — stop the trigger (stop antibiotic, stop sugammadex/rocuronium infusion, remove latex source)
L
LIFT — legs to 30° (autotransfusion); turn FiO2 to 1.0; call for help
A
ADRENALINE — epinephrine IM 0.5 mg or IV 10-100 mcg titrated; q1-2 min if needed; infusion 0.05-0.5 mcg/kg/min for refractory
Clinical note: Send tryptase × 3 (immediate, 1 hr, 24 hr — supports diagnosis). Adjuncts: H1 (diphenhydramine 50 mg), H2 (famotidine 20 mg), steroid (hydrocortisone 200 mg, dex 8 mg) — these are SECONDARY, never delay epi for them. Refer to allergist for skin testing.