Intravenous Anesthesia in Modern Surgery. (Sodium-Pentothal-Oxygen)

Davison, T. C.

doi:10.1213/00000539-194301000-00007

Cited by 6 publications

(4 citation statements)

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“…Allergy from thiopental, a short-acting barbiturate anaesthetic, was first reported during World War II (110). Older estimates of reaction prevalence range from 1 in 30 000 (111) up to 1 in 400 (112), but in more recent surveys anaphylaxis from thiopental sodium is only rarely or even not observed, probably as a result from less intensive application (3,(14)(15)(16)18).…”

Section: Hypnoticsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

193

197

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Anaesthesiologists administer several drugs while providing general anaesthesia. Many of these drugs can elicit adverse drug reactions that fall apart into two major types. First, reactions that are usually dose-dependent and related to the pharmacological properties of the drug and/or its metabolites. Second, reactions that are unrelated to the drug's pharmacological characteristics and that are less dose-dependent. These reactions comprise drug intolerance, idiosyncratic reactions and drug-induced immune-mediated allergic and nonimmune-mediated so-called pseudo-allergic or anaphylactoid reactions. The terms anaphylactic and anaphylactoid, however, have been used inconsistently in the literature. Therefore, the nomenclature task force set up by the European Academy of Allergy and Immunology (EAACI) has proposed that anaphylactic-type reactions should be reclassified into allergic anaphylaxis and nonallergic anaphylaxis. Allergic anaphylaxis being further subdivided in IgE-mediated and non-IgE-mediated reactions (1).The exact prevalence of anaphylaxis during anaesthesia is difficult to ascertain. The estimated overall frequency has been reported to vary between 1 in 3500 and 1 in 13 000 procedures in French series (2, 3) and between 1 in 10 000 and 1 in 20 000 in an Australian study (4). The clinical manifestation of these reactions is not infrequently an almost immediate generalized response with bronchospasm and hypotension. The degree of severity varies and does not allow differentiation between an IgE-mediated or non-IgE mediated reaction resulting from nonspecific mediator release (5). The mortality from these reactions is in the range from 3 to 6%, and an additional 2% of patients experience significant residual brain damage (4).Diagnosis of anaphylaxis during anaesthesia is not always straightforward. It can be hampered as a broad spectrum of different drugs can elicit heterogeneous allergic and nonallergic reactions with distinct and sometimes unclear pathological mechanisms. Problems are certainly compounded as multiple drugs need to be administered during general anaesthesia. In addition, nonanaesthesia related drugs or procedures (e.g. disinfection) are sometimes administered/performed in the perioperative period and can also be the cause of an allergic reaction.In addition, none of the available diagnostic tests demonstrates absolute accuracy. False-positive test Correct management of anaphylaxis during anaesthesia requires a multidisciplinary approach with prompt recognition and treatment of the acute event by the attending anaesthesiologist, and subsequent determination of the responsible agent(s) with strict avoidance of subsequent administration of all incriminated and/or cross-reacting compounds.However, correct identification of the causative compound(s) and safe alternatives is not always straightforward and, too often, not done.This review is not intended to discuss acute management of anaesthesia-related anaphylaxis but summarizes the major causes of anaphylaxis during anaesthesia and the di...

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Section: Hypnoticsmentioning

confidence: 99%

Anaphylaxis during anaesthesia: diagnostic approach

Ebo¹,

Fisher²,

Hagendorens³

et al. 2007

Allergy

193

197

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“…Anaphylactic/anaphylactoid reactions can occur during the intravenous administration of general anaesthetics and there is evidence that many of these compounds can induce histamine release from mast cells and basophils [62][63][64]. The short acting barbiturate thiopental was one of the first drugs used in anaesthesia reported to cause adverse reactions [64].…”

Section: General Anaestheticsmentioning

confidence: 99%

“…The short acting barbiturate thiopental was one of the first drugs used in anaesthesia reported to cause adverse reactions [64]. Thiopental induces basophil and mast cell activation involves both immunological and non-immunological mechanisms [63,[65][66][67].…”

Section: General Anaestheticsmentioning

confidence: 99%

Clinical consequences of mast cell heterogeneity

Forsythe¹,

Ennis²

2000

Inflammation Research

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The heterogeneous morphological, biochemical and functional characteristics of mast cells from different species and from different tissue sites in the same species have been described for over 30 years. Far from being mere histochemical or pharmacological curiosities these differences have far reaching implications for therapeutic practice. This review concentrates on two important areas affected by mast cell heterogeneity, those of adverse reactions to therapeutic agents and the efficacy of anti-allergy therapy. In vitro studies of preformed and de novo synthesised mediator release have demonstrated a wide variability in the response of basophils and isolated mast cells to anti-allergy drugs and therapeutic agents such as radiographic contrast media, general anaesthetics, opioids and muscle relaxants. This heterogeneity is not limited to the mast cell's tissue of origin as there is also variability in the response of basophils and mast cells from different donors to the same drug or agent. These data have considerable clinical implications for the study of adverse drug reactions and the design of novel anti-allergic drugs.

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“…Different classes of compounds can be used, such as barbiturates (thiopental and methohexital) or nonbarbiturate chemically unrelated drugs (propofol and ketamine). Thiopental, a short-acting barbiturate, was among the first drugs used in anesthesia reported to cause adverse reactions [62]. Both immunological [6,30] and non-immunological mechanisms [33,61] are involved in thiopental-induced basophil and mast cell activation.…”

Section: General Anestheticsmentioning

confidence: 99%

Role of Mast Cells, Basophils and Their Mediators in Adverse Reactions to General Anesthetics and Radiocontrast Media

Genovese

Stellato

Marsella

et al. 1996

Int Arch Allergy Immunol

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General anesthetics and radiocontrast media (RCM) can cause anaphylactic or anaphylactoid reactions. These are usually underdiagnosed and underreported, but their incidence is apparently rising. Their pathogenesis is complex and not completely understood, but the release of vasoactive mediators from basophils and mast cells plays a central role. The recent development of in vitro techniques to study the release of preformed (histamine and tryptase) and de novo synthesized mediators (PGD₂, LTC₄, and PAF) from purified basophils and mast cells has made it possible to quantify the mediator-releasing activity of anesthetics such as muscle relaxants, general anesthetics, opioids, and benzodiazepines and RCM on human basophils and mast cells isolated from lung, skin and heart tissues. The majority of general anesthetics and RCM tested induced only the release of preformed mediators (histamine and tryptase), not of the de novo synthesized eicosanoids. There was wide variability in the response of basophils and mast cells from different donors to the same drug or RCM, presumably due to the releasability parameter. Hyperosmolality is probably not the only factor responsible for basophil and mast cell activation by RCM. The in vitro release of histamine induced by anesthetic drugs and RCM was correlated with the release of tryptase. Given the longer half-life of tryptase than histamine in plasma, measurements of plasma tryptase may become a useful diagnostic tool for identifying adverse reactions to anesthetics and RCM.

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Intravenous Anesthesia in Modern Surgery. (Sodium-Pentothal-Oxygen)

Cited by 6 publications

References 0 publications

Anaphylaxis during anaesthesia: diagnostic approach

Anaphylaxis during anaesthesia: diagnostic approach

Clinical consequences of mast cell heterogeneity

Role of Mast Cells, Basophils and Their Mediators in Adverse Reactions to General Anesthetics and Radiocontrast Media

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