What is the treatment of choice for anaphylaxis during surgery?

• A. IV epinephrine
• B. Oral steroids
• C. Antihistamines
• D. IV fluids only

Answer: (A)

Anaphylaxis in the operating room requires immediate reversal of the life-threatening airway, breathing, and circulation compromise. Epinephrine is the drug that does this most effectively because it acts on multiple receptors to counteract the reaction: alpha-1 causes vasoconstriction to raise blood pressure and reduce airway edema; beta-1 boosts cardiac output; beta-2 leads to bronchodilation. In the perioperative setting, IV administration allows rapid, controlled titration to address severe hypotension and bronchospasm as they arise. Steroids and antihistamines don’t work quickly enough to reverse the acute symptoms and are used as adjuncts later on, while IV fluids help with volume status but won’t resolve airway obstruction or bronchospasm by themselves. So, IV epinephrine is the best first-line treatment for intraoperative anaphylaxis.