skip to main content

Peri-operative anaphylaxis — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardGeneral AnaesthesiaPeri-operative anaphylaxisFRCA Final

A 64-year-old woman develops severe hypotension, bronchospasm and an urticarial rash within minutes of cefuroxime at induction for colorectal surgery. Capnography shows a sustained trace, SpO2 is 88% on 100% oxygen, and systolic blood pressure is 55 mmHg despite stopping the antibiotic. What is the most important next step?

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

Reveal the answer and explanation

Correct answer: E — Give intravenous adrenaline and rapid crystalloid boluses

The presentation is severe peri-operative anaphylaxis with airway and circulatory compromise, requiring early intravenous adrenaline titrated to response and aggressive fluid resuscitation. Antihistamine and steroid therapy are adjuncts and should not delay adrenaline. Intramuscular adrenaline is appropriate in many non-theatre settings, but an anaesthetised patient with invasive monitoring and shock needs IV treatment by an anaesthetist. The trigger should be removed and mast-cell tryptase samples arranged after resuscitation.

Reference: Resuscitation Council UK peri-operative anaphylaxis algorithm 2024