hereditary angioedema

[Gas you down]

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so the patient has a cc of belly pain, now he is here and ready to get an appy.
His known trigger is stress. In the past, the swelling was mostly in the hands and abdominal cavity.. He takes Danazol. He is currently asymtomatic....
he is scared to death, but not of the surgery, just of his HAE ruining his/our day.
straight to OR? do anything else?

 

[Planktonmd]

If he is going to develop Angioedema it's not going to happen right away and most likely will happen next day.
Take him to the OR then watch him 48 hours post-op, if he develops edema treat it.

 

[Gas you down]

If he is going to develop Angioedema it's not going to happen right away and most likely will happen next day.
Take him to the OR then watch him 48 hours post-op, if he develops edema treat it.

yeah, that was my initial gut thinking, but decided to do some reading and this article popped up.

http://www.anesthesia-analgesia.org/content/110/5/1271.full.pdf+html

looks like they recommend some Amicar/TEA. and for an acute abdomen requiring intubation, you should consider FFP prior to surgery if the C1-Inh conc isn't available (of course not, and we can't get it, either)
and 8hrs is median onset according to the article.

so just observe and this?

 

[lord_jeebus]

There are now several alternatives to C1INH concentrate, including at least one that is not derived from blood products called ecallantide. I don't know how hard it is for a hospital pharmacy to get it, I've never had to try.

 

[DrBeaker]

according to the article gas you down posted, ecallantinde has a risk of anaphylaxis. I would use C1-INH concentrate if available, and TXA. C1-INH, according to the article, is well tolerated and effective. I realize it is giving blood product. Thanks for the article, definitely learned something there.

 

[Noyac]

Blue rhino