Role of Adrenaline Premedication in Reducing Anti-Snake Venom Induced Adverse Reactions in Children
Poovazhagi V1, A Anupama2, Nisha R2, Monisha A2, Asvatha VC2.
1Department of Pediatric Intensive care Unit, Institute of Child Health and Hospital for Children, Egmore, Chennai, India,
2Department of Pediatrics, Chengalpattu Medical College, Chennai, India.
Abstract
Aim: This prospective study was undertaken to identify whether premedication with subcutaneous adrenaline at a dose of 0.01 mg/kg of 1 in 1000 solution is effective in reducing the adverse reactions following anti-snake venom (ASV) administration in children.
Methods and Material: This prospective study was conducted over 3 years from 2015-2018 in children who received ASV injection at the pediatric intensive care unit (PICU) of our institute. Children who had received ASV elsewhere prior to referral were excluded from the study. Those children recruited between 2015 and 2016 were considered as group 1 without premedication and those recruited between 2017 and 2018 were considered as group 2 with adrenaline premedication. Study parameters included the type of snake envenomation and adverse reactions following ASV administration in both groups. Children were followed up till 12 weeks after discharge from the hospital.
Results: Among the 65 children admitted during the study period, 9 children did not have signs of envenomation, 5 children had already received ASV prior to referral, and hence 51 children were recruited for the study of which 30 children did not receive premedication (Group 1) and 21 children received premedication (Group 2). Overall incidence of adverse reactions was significantly lower in the premedication group in comparison to the group with no premedication (8/21 vs 18/30) (p=0.04). Fever (none in group 2 vs 6/30 in group 1 with p 0.032), rashes (8/21 vs 18/30, p=0.04), and anaphylaxis (4/21 vs 14/30, p=0.038) were significantly lower following premedication with subcutaneous adrenaline.
Conclusion: Premedication with subcutaneous adrenaline leads to lesser adverse effects in children receiving ASV.

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