Severe Histamine Mediated Reactions to Intravenous Drugs Used in Anaesthesia

Fisher, M. McD.

doi:10.1177/0310057x7500300303

Cited by 72 publications

(18 citation statements)

References 88 publications

(36 reference statements)

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“…In France (11)(12)(13)(14), Australia (15)(16)(17)(18) and Great Britain (19)(20)(21)(22), follow-up investigations have been carried out after anaphylactic reactions in anaesthesia for the past 20-30 years. In France, surveys with results of follow-up have been published (13,23,24) for large numbers of patients, and these have repeatedly shown that neuromuscular blocking agents (NMBAs) are the most common causative agent, followed by latex and antibiotics.…”

Section: Causesmentioning

confidence: 99%

Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow‐up of anaphylaxis during anaesthesia*

Krøigaard

Garvey

Gillberg

et al. 2007

Acta Anaesthesiol Scand

251

314

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The present approach to the diagnosis, management and follow‐up of anaphylaxis during anaesthesia varies in the Scandinavian countries. The main purpose of these Scandinavian Clinical Practice Guidelines is to increase the awareness about anaphylaxis during anaesthesia amongst anaesthesiologists. It is hoped that increased focus on the subject will lead to prompt diagnosis, rapid and correct treatment, and standardised management of patients with anaphylactic reactions during anaesthesia across Scandinavia. The recommendations are based on the best available evidence in the literature, which, owing to the rare and unforeseeable nature of anaphylaxis, mainly includes case series and expert opinion (grade of evidence IV and V). These guidelines include an overview of the epidemiology of anaphylactic reactions during anaesthesia. A treatment algorithm is suggested, with emphasis on the incremental titration of adrenaline (epinephrine) and fluid therapy as first‐line treatment. Recommendations for primary and secondary follow‐up are given, bearing in mind that there are variations in geography and resources in the different countries. A list of National Centres from which anaesthesiologists can seek advice concerning follow‐up procedures is provided. In addition, an algorithm is included with advice on how to manage patients with previous suspected anaphylaxis during anaesthesia. Lastly, provides an overview of the incidence, mechanisms and possibilities for follow‐up for some common drug groups.

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Section: Causesmentioning

confidence: 99%

Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow‐up of anaphylaxis during anaesthesia*

Krøigaard

Garvey

Gillberg

et al. 2007

Acta Anaesthesiol Scand

251

314

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“…The anaphylactic reactions to dextran administered intravenously are well documented (5). During the last few years anaphylactic reactions even after intraperitoneal administration have been reported (1).…”

Section: 23 24 28)mentioning

confidence: 99%

Effect of Intraperitoneal Instillation of 32% Dextran 70 on Postoperative Adhesion Formation after Tubal Surgery

Larsson

Lalos

Marsk

et al. 1986

Obstetrical & Gynecological Survey

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The intraperitoneal instillation of 32% dextran 70 (HyskonR, Pharmacia AB, Sweden) has previously been reported to prevent the formation of postoperative adhesions. Against this background, the present study was undertaken to evaluate the efficacy of HyskonR in counteracting peritoneal adhesions following tubal microsurgery. 105 infertile women were operated upon in a prospective, randomized, controlled, double-blind, multicenter study. The intra-abdominal adhesions present from the beginning were classified by means of a standardized scoring scale and the extent of adhesions was again evaluated at follow-up laparoscopy 4-10 weeks later. A reduction in the extent of the intraabdominal adhesions (statistically highly significant) was revealed in both the Hyskon group and the saline control group. The extent of adhesions in the Hyskon group was not lesser than in the saline group, however. The pregnancy rates in the two groups were also similar.

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“…The solubilizing agent for Saffan Ò was a polyethoxylated castor oil, Cremophor Ò -EL, which caused histamine release in animals by stimulating mast cell degranulation. This histamine released caused unacceptable adverse events (Clarke et al, 1975;Fisher, 1975;Dodman, 1980;Ennis & Lorenz, 1985). Because alfaxalone has a wide margin of safety, a formulation containing no Cremophor Ò -EL has been a target of research for some years (Brewster et al, 1989).…”

Section: Introductionmentioning

confidence: 99%

The pharmacokinetics and pharmacodynamics of alfaxalone in cats after single and multiple intravenous administration of Alfaxan^®at clinical and supraclinical doses

Whittem

Pasloske

Heit³

et al. 2008

Vet Pharm & Therapeutics

117

128

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This study aimed to determine the pharmacokinetic parameters and pharmacodynamics of alfaxalone in a 2-hydroxypropyl-beta-cyclodextrin alfaxalone formulation (Alfaxan), Jurox Pty Ltd, Rutherford, NSW, Australia) in cats after single administration at clinical and supraclinical dose rates and as multiple maintenance doses. First, a prospective two-period cross-over study was conducted at single clinical and supraclinical doses. Second, a single group multiple dose study evaluated the effect of maintenance doses. Eight (five female and three male) domestic cats completed the cross-over experiment and six female cats completed the multiple dose study. In the first experiment, alfaxalone was administered intravenously (IV) at 5 or 25 mg/kg with a washout period of 14 days. In the second experiment, alfaxalone was administered IV at 5 mg/kg followed by four doses each of 2 mg/kg, administered at onset of responsiveness to a noxious stimulus. Blood was collected at prescribed intervals and analysed by LCMS for plasma alfaxalone concentration. Noncompartmental pharmacokinetics were used to analyse the plasma alfaxalone data. The plasma clearance of alfaxalone at 5 and 25 mg/kg differed statistically at 25.1 and 14.8 mL/kg/min respectively. The elimination half lives were 45.2 and 76.6 min respectively. Alfaxalone has nonlinear pharmacokinetics in the cat. Nevertheless, for cats dosed with sequential maintenance doses, a regression line through their peak plasma concentrations indicated that there was no clinically relevant pharmacokinetic accumulation. The duration of nonresponsiveness after each maintenance dose was similar at approximately 6 min, indicating a lack of accumulation of pharmacodynamic effect. The cardiovascular and respiratory parameters measured in cats after administration of the labelled doses of Alfaxan were stable. In conclusion, the pharmacokinetics of alfaxalone in cats are nonlinear. At clinical dose rates, however, neither alfaxalone nor its effects accumulated to a clinically relevant extent. Further, in the un-premedicated cat the induction and maintenance of surgical anaesthesia was free of untoward events after a dose of 5 mg alfaxalone/kg body weight followed by four sequential doses of 2 mg/kg as needed (i.e., approximately 7 to 8 mg/kg/h).

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Severe Histamine Mediated Reactions to Intravenous Drugs Used in Anaesthesia

Cited by 72 publications

References 88 publications

Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow‐up of anaphylaxis during anaesthesia*

Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow‐up of anaphylaxis during anaesthesia*

Effect of Intraperitoneal Instillation of 32% Dextran 70 on Postoperative Adhesion Formation after Tubal Surgery

The pharmacokinetics and pharmacodynamics of alfaxalone in cats after single and multiple intravenous administration of Alfaxan^®at clinical and supraclinical doses

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Severe Histamine Mediated Reactions to Intravenous Drugs Used in Anaesthesia

Cited by 72 publications

References 88 publications

Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow‐up of anaphylaxis during anaesthesia*

Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow‐up of anaphylaxis during anaesthesia*

Effect of Intraperitoneal Instillation of 32% Dextran 70 on Postoperative Adhesion Formation after Tubal Surgery

The pharmacokinetics and pharmacodynamics of alfaxalone in cats after single and multiple intravenous administration of Alfaxan®at clinical and supraclinical doses

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The pharmacokinetics and pharmacodynamics of alfaxalone in cats after single and multiple intravenous administration of Alfaxan^®at clinical and supraclinical doses