Allergic reactions occurring during anaesthesia

Mertès, Paul-Michel; Laxenaire, M.C.

doi:10.1097/00003643-200204000-00002

Cited by 68 publications

(73 citation statements)

References 225 publications

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“…16 Typically, bronchospasm is not a dominant sign of anaphylaxis during anesthesia, but atopic individuals (asthmatics), such was this patient, can experience both bronchospasm and hypotension due to exaggerated release and response to chemical mediators released from the mast cells or basophils. 17 An effective approach to the differential diagnosis and management of hypersensitivity reactions during anesthesia has been detailed elsewhere. 18 Proper timing of laboratory studies, such as blood and urine tests can be helpful in distinguishing hypersensitivity reactions from other causes.…”

Section: Discussionmentioning

confidence: 99%

Case report: Intraoperative anaphylactoid reaction and hydroxyethyl starch in balanced electrolyte solution (Hextend®)

Hall¹,

Frigas²,

Matešić³

et al. 2006

Can J Anesth/J Can Anesth

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Purpose:To report a first case of probable anaphylactoid reaction to 6% hydroxyethyl starch reconstituted in balanced electrolyte and glucose solution (Hextend ® ). Clinical features:A 22-yr-old man was admitted for a partial nephrectomy. Near the end of the four-hour operation, an infusion of Hextend ® was initiated. Shortly thereafter, mechanical ventilation became difficult, peak inspiratory pressure increased to 55 cm H 2 O with audible wheezing over the patient's lungs. Blood pressure suddenly decreased to 68/46 mmHg. Multiple doses of phenylephrine, ephedrine and epinephrine were required to restore the patient's blood pressure. Postoperatively, a diffuse urticarial rash was apparent on his upper torso. The patient recovered uneventfully. His postoperative serum tryptase was 26.3 ng·mL -1 (reference range, < 11.5 ng·mL -1 ) and the urine N-methyl-histamine was 2448 µg·g -1 creatinine (reference range, 30-200 µg·g -1 creatinine). Two months after the event, skin testing was conducted to test for possible allergy to latex, lidocaine, propofol, cisatracurium, succinylcholine, vecuronium, midazolam, fentanyl, ondansetron, neostigmine, and cephazolin, and all were negative. Hextend ® was also tested, starting with a 1:100,000 dilution and the results were negative. Conclusions:The temporal relationship of severe hypotension, bronchospasm and skin rash within ten minutes from administration of Hextend ® in this patient suggests an immediate hypersensitivity reaction to hetastarch. The elevated levels of serum tryptase and urinary N-methyl-histamine suggest that this hypersensitivity was mediated from mast cell degranulation. Negative skin testing suggests that the reaction was anaphylactoid. Objectif

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Section: Discussionmentioning

confidence: 99%

Case report: Intraoperative anaphylactoid reaction and hydroxyethyl starch in balanced electrolyte solution (Hextend®)

Hall¹,

Frigas²,

Matešić³

et al. 2006

Can J Anesth/J Can Anesth

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“…Venous blood gas and electrolytes drawn at the time of the episode showed pH 7.3, pCO 2 Seven weeks later, the patient received skin prick and intradermal testing for all of the drugs administered and suspected agents. Concentrations for skin prick testing were propofol (Diprivan, AstraZeneca) 1:1, remifentanil 50 lg/mL, atropine 1:100, and fentanyl 1:10.…”

Section: Clinical Eventsmentioning

confidence: 99%

“…It is estimated that the incidence of allergy under anesthesia is 1:6000 to 1:20,000 but is most likely underreported in the literature with suboptimal accuracy, completeness, and varying reporting protocols. [1][2][3][4][5] It is well known that muscle paralyzers are the most commonly implicated agent with anaphylaxis under general anesthesia. 6 However, the patient is exposed to a wide variety of anesthetic, surgical, and supportive agents in the operating theater.…”

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confidence: 99%

Suspected Intraoperative Anaphylaxis to Gelatin Absorbable Hemostatic Sponge

Barrett²

2015

Anesthesia Progress

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“…13 Pretreatment with corticosteroids or with H1 antihistamines is still controversial. 14 These substances have been indicated for patients at high risk of having adverse reactions to iodine contrast media. 51 The clinical management of patients with AR is complicated because the pathophysiology and predisposing factors for these reactions are unknown.…”

Section: Clinical Managementmentioning

confidence: 99%

“…12 Drug-induced anaphylactic reactions are believed to occur in approximately 0.95% of the general population. [13][14][15] Although anaphylactic reaction to penicillin is a rare event, this drug is still accountable for around 75% of fatal cases of anaphylaxis in the United States every year. 16 Thong et al, 2 in a prospective study conducted between 1997 and 1999, in a general hospital of Singapore, assessed approximately 90,910 admissions, of which 366 were due to adverse reactions, and of these 72 were AR (19%).…”

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confidence: 99%

Reações alérgicas a medicamentos

Nagão-Dias¹,

Barros-Nunes²,

Coêlho³

et al. 2004

J. Pediatr. (Rio J.)

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Objective: This review addresses the most recent published literature regarding drug allergy, in order to provide physicians with a background for a better understanding of this problem of great relevance for public health. Sources of data:The sources of data for obtaining the original and review articles published in the last 10 years were MEDLINE, Pubmed and Lilacs. The articles chosen for this review relate drug allergy to immunological mechanisms, epidemiology, clinical and laboratory evaluation, skin lesions, clinical management, and re-exposure to the drug.Summary of the findings: Allergic reactions represent one third of adverse drug reactions. They are considered rare but with high morbimortality. Gell & Coombs definition has been useful for classifying some types of drug allergic reactions; however, some still remain without classification because of poor knowledge of the mechanisms involved. The existence of T cell subpopulations with diverse characteristics reveals the complexity of the subject and, at the same time, elucidates several questions raised about it. It was recently postulated a new concept of chemically inert drug presentation to T cells, restricted to the major histocompatibility complex, but in a non-covalent and labile way. In clinical practice, without adequate laboratory tests, it is difficult to correlate clinical symptoms and immunological mechanisms. In vitro and in vivo skin tests have been employed in cases of suspected drug allergy reaction. However, there are very few commercially available reagents.Conclusions: Drug allergy constitutes an important problem in adverse drug reactions because of its potential of morbidity and mortality. It is necessary to emphasize the relevance of pharmacovigilance during treatment of patients, as well as the identification of possible immunological mechanisms involved in the events, through laboratory tests and detailed history and clinical evaluation.

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Allergic reactions occurring during anaesthesia

Cited by 68 publications

References 225 publications

Case report: Intraoperative anaphylactoid reaction and hydroxyethyl starch in balanced electrolyte solution (Hextend®)

Case report: Intraoperative anaphylactoid reaction and hydroxyethyl starch in balanced electrolyte solution (Hextend®)

Suspected Intraoperative Anaphylaxis to Gelatin Absorbable Hemostatic Sponge

Reações alérgicas a medicamentos

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