- Angioedema can cause life-threatening upper airway obstruction (Chapter 59); early recognition and airway management should be a priority (Chapter 112).
- If airway obstruction present or imminent alert anaesthetist; consider intervention early as advanced laryngeal oedema will distort anatomy and make intubation difficult.
If features of anaphylaxis are present (Chapter 38) - Give adrenaline 500 μgm IM into anterolateral thigh using a 23G needle (blue – length 25 mm); in morbidly obese use 21 G needle (green – length 38 mm) or administer to calf. Repeat every five minutes as needed.
- Give hydrocortisone 200 mg IV and chlorphenamine 10 mg IV.
If features of anaphylaxis are absent If mast cell mediated - Give hydrocortisone 200 mg IV and chlorphenamine 10 mg IV
- Consider nebulized adrenaline (5 mL of 1:1000 solution)
- Continue to observe for progression or biphasic reactions
If related to angiotensin-converting-enzyme inhibitor (ACEi) Ifhereditary angioedema (HAE) or
acquired angioedema (AAE) known or likely - C1 inhibitor concentrate 20 units/kg (round up to nearest 500 units) IV slow infusion (1 mL/min)
- Icatibant 30 mg SC (maximum 3 doses in 24 hours)
- Discuss with on-call immunologist; consider repeat dose if no improvement within 30–60 min
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