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Perioperative Anaphylaxis — FRCA Final MCQ

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ModerateGeneral AnaesthesiaPerioperative AnaphylaxisFRCA Final

A 55-year-old man is undergoing total hip replacement under general anaesthesia with continuous monitoring and a patent intravenous cannula. Thirty minutes after skin incision, he develops tachycardia at 140 beats min−1, a blood pressure of 65/30 mmHg, bronchospasm and widespread urticaria. He has a palpable pulse. Perioperative anaphylaxis is suspected. According to current UK perioperative anaphylaxis guidance, what is the recommended initial adrenaline dose and route?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Intravenous adrenaline 50 micrograms, titrated to response

The correct answer is D. In monitored perioperative anaphylaxis managed by an anaesthetist with intravenous access, give an initial 50-microgram intravenous adrenaline bolus and titrate to the haemodynamic response. Simultaneously stop or remove suspected triggers, give 100% oxygen and administer a rapid intravenous crystalloid bolus, initially 500–1000 mL in an adult. Start an adrenaline infusion if repeated boluses produce an inadequate or transient response. Intramuscular adrenaline 0.5 mg is appropriate when intravenous access is unavailable but is not preferred in this setting. Chlorphenamine and hydrocortisone do not reverse life-threatening vasodilatation, capillary leak or bronchospasm rapidly and are not initial resuscitation drugs. Nebulised adrenaline does not provide adequate systemic treatment for profound hypotension.

Reference: Royal College of Anaesthetists, ACSA 2025 Annual Forum master slides, section 'Peri-operative anaphylaxis', 2025. https://www.rcoa.ac.uk/sites/default/files/documents/2025-08/Master%20Slides%20-%20ACSA%202025%20Annual%20Forum%20-%20Website.pdf