Perioperative Anaphylaxis

Mertès, Paul-Michel; Lambert, M.; Guéant-Rodriguez, R.-M.; Aimone-Gastin, I.; Mouton‐Faivre, C.; Moneret‐Vautrin, D.A.; Guéant, Jean‐Louis; Malinovsky, Jean‐Marc; Démoly, P.

doi:10.1016/j.iac.2009.04.004

Cited by 151 publications

(116 citation statements)

References 93 publications

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“…Ayrıca genetik faktörlerin de önemli olduğu bildirilmiştir. Tip 1 hipersensitivite reaksiyonunun tahmini görülme oranı tüm anestezi vakaları arasında 1:1250 ve 1:10000'dir (11). Çoğu serilerde, Tip 1 reaksiyonlar perioperatif süre içinde gözlenen tüm aşırı duyarlılık reaksiyonlarının en az %60'ını temsil eder.…”

Section: Olgu Sunumuunclassified

Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions

Hakimoğlu¹,

Tuzcu²,

Davarcı³

et al. 2015

Turk J Anesth Reanim

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Anaesthesia represents a specific set-up in respect to pharmacology, and during this time, early hypersensitivity reactions or anaphylaxis may occur in patients who are exposed to a great number of foreign substances. Intravenous ephedrine (5 mg) was applied to a 37-yearold patient due to the development of intraoperative hypotension in a total abdominal hysterectomy operation. After application, hyperaemia was seen in the track of the intravenous catheter of that extremity. Approximately 15 minutes later, urticarial plaques were observed extensively in the abdomen and in both extremities. Methylprednisolone (100 mg+100 mg) and pheniramine (45.5 mg) were given with an increasing infusion rate of intravenous crystalloid. The patient was extubated without any problem and removed to the recovery unit for observation. After the total disappearance of lesions at postoperative 60 minutes and because of the stability of vital signs, the patient was removed to the service. In the follow-up of surgery, no complication developed, and the patient was discharged on postoperative day 2. Keywords: Ephedrine, intraoperative, hypersensitivity reactionsKemoterapi almış hastada intraoperatif efedrin alerjisi ve perioperatif hipersensitivite reaksiyonları anestezi, farmakolojik açı-dan özgül bir durumu temsil eder ve bu süre boyunca çok sayıda yabancı maddelere maruz kalan hastalarda erken aşırı duyarlılık reaksiyonları veya anafilaksi gelişebilir. Otuz yedi yaşındaki, total abdominal histerektomi planlanan hastada intraoperatif hipotansiyon gelişmesi nedeniyle (5 mg) efedrin iv uygulandı. Uygulama sonrası aynı ekstremitenin iv kanülün yerleştirildiği ven trasesi hattında kızarıklık görüldü. Yaklaşık 15 dakika sonra her iki ekstremitede, batında yaygın ürtiker plakları gözlendi. İntra-venöz kristalloid infüzyon hızı arttırılarak, metilprednisolon (100 mg+100 mg), Feniraminmaleat (45,5 mg) verildi. Postoperatif sorunsuz ekstübe edilerek postoperatif bakım ünitesinde gözleme alındı. Lezyonları postoperatif 60. dakikada tamamen ortadan kalkmasının ardından yaşamsal bulgularının da istikrarlı olması nedeniyle servise alındı. Cerrahi takibinde herhangi bir komplikasyon gelişmeyen hasta yatışının ikinci gününde taburcu edildi. 130 GirişA lerjik ilaç reaksiyonları ilaçlara bağlı tüm istenmeyen etkilerin %6-10'unu oluşturur. İlaç reaksiyonunu Dünya Alerji Organizasyonu, IgE veya T hücre aracılıklı hipersensitivite reaksiyonları ile oluşuyorsa ilaç alerjisi olarak tanımlamış-tır. İlaç alerjisi kendisini en fazla deri bulguları ile göstermektedir (1).Anestezi sırasında kullanılan ilaçlardan genel anestetikler, lokal anestetikler, kas gevşeticiler, opioidler, antibiyotikler, intravenöz sıvılardan volüm genişleticiler ve kan ürünleri gibi birçok etkene karşı duyarlı hastalarda alerjik reaksiyon görüldü-ğü bilinmektedir. Anestezi sırasında, anafilaksi ya da anafilaktoid reaksiyondan sorumlu olabilecek pek çok ilaç bir arada kullanıldığı için sorumlu ajanı saptamak güçtür. Bu ilaçlardan genel anestezi sırasında en sık kas gevşeticilere karşı a...

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Section: Olgu Sunumuunclassified

Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions

Hakimoğlu¹,

Tuzcu²,

Davarcı³

et al. 2015

Turk J Anesth Reanim

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“…Brought to you by | MIT Libraries Authenticated Download Date | 5/11/18 8:50 PM lower (13). Sensitivity of skin tests might decrease over time, a phenomenon particularly relevant for antibiotics (14), thus false negative results might occur.…”

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confidence: 99%

Basophil activation test versus radio-immunoassay in the diagnosis of β-lactam immediate-type hypersensitivity reactions

Petrișor¹,

Gherman-Ionica²,

Bologa³

et al. 2013

Romanian Review of Laboratory Medicine

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“…Anaphylactic shock is a rare (approximately one case in 10,000-20,000 procedures) but life-threatening complication of anesthesia. 1 In France, various epidemiological studies over the last three decades have shown that the most common causal agents of anaphylaxis are NMBs. 2 In the event of anaphylactic shock, epinephrine is the first-line therapy.…”

mentioning

confidence: 99%

“…In the case of a potentially fatal emergency situation such as anaphylactic shock, a controlled trial appears difficult to undertake, particularly as this event is rare. 1 Therefore, what value can we give to the various published case reports? It is probable that only cases with a positive outcome were submitted for publication.…”

mentioning

confidence: 99%

“…L'anaphylaxie, dont la forme la plus grave est représentée par l'état de choc, est une complication rare de l'anesthésie (un cas pour 10 000 à 20 000 interventions) et pouvant engager le pronostic vital. 1 Dans ce contexte, en France, les agents le plus souvent mis en cause dans les différentes enquêtes épidémiologiques menées depuis trente ans sont les curares. 2 L'adrénaline, donnée le plus précocement possible, à doses titrées -à moins qu'il y ait un arrêt cardiaque d'emblée-en fonction de la fréquence cardiaque et de la tension artérielle afin d'éviter l'apparition de troubles du rythme en cas de doses initiales trop fortes, est le médicament à administrer sans délai et en première intention.…”

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A new option for the treatment of anaphylaxis linked to steroidal neuromuscular blockers: How much value should we grant to case reports?

Plaud

2014

Can J Anesth/J Can Anesth

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Neuromuscular blockers (NMBs) are commonly used in anesthesia to facilitate tracheal intubation and optimize surgical conditions. However, these compounds share a common side effect -the risk of an allergic reaction. Anaphylactic shock is a rare (approximately one case in 10,000-20,000 procedures) but life-threatening complication of anesthesia. 1 In France, various epidemiological studies over the last three decades have shown that the most common causal agents of anaphylaxis are NMBs. 2 In the event of anaphylactic shock, epinephrine is the first-line therapy. The dose is usually titrated -except in case of cardiac arrest -depending on the clinical presentation and based on heart rate and blood pressure, to avoid the occurrence of arrhythmia with large doses of epinephrine. 3 This symptomatic treatment, coupled with crystalloid fluid resuscitation, allows to counteract hemodynamic (decreased blood pressure and cardiac output) and respiratory (bronchoconstriction) effects of the numerous mediators that are released during the course of an anaphylactic reaction. Despite these measures, the outcome remains potentially lethal in approximately 10% of cases. 4 However, there is no specific therapy of NMBassociated anaphylaxis. Proposed therapies could involve a substance able to rapidly inhibit the anaphylactic reaction by masking or binding the causal allergen. A specific therapy for the anaphylactic reaction to dextran, used in some countries as a fluid therapy, was attempted during the 1980s with the arrival on the market of a dextran-inhibitor hapten. 5 This hapten was purported to reduce the allergystimulating effects of dextrans through specific inhibition. The effectiveness of this preventive strategy proved unreliable, notwithstanding the other adverse effects of dextrans, renal in particular. 6 Thus, there remains no specific strategy at this time regarding the prevention or treatment of allergic reactions to NMBs. Could this situation change with the recent availability of sugammadex? Sugammadex is a gammacyclodextrine that was modified by the addition of side chains that specifically encapsulate the steroidal core of the NMB, mainly through interactions between the negative charges of the cyclodextrine molecule and the positive charges of the quaternary ammonium ions. 7 Their binding at the centre of the cyclodextrine molecule, more specifically the sterol moiety, is strong and prolonged, implying the presence of various high-energy chemical bonds. Binding is rapid, and steroidal NMBs show a high affinity for sugammadex, especially rocuronium and to a lesser degree vecuronium. 8 Beyond the rapid reversal of NMBs allowed by sugammadex, 7 neutralizing the NMB molecules by masking the causal allergen (i.e., the quaternary ammonium ion) should also be considered when an NMB-related allergic event is suspected. This hypothesis was reported for the first time through a case report. 9 The authors of that report described a serious anaphylactic reaction that occurred immediately after an induction sequence that i...

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Perioperative Anaphylaxis

Cited by 151 publications

References 93 publications

Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions

Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions

Basophil activation test versus radio-immunoassay in the diagnosis of β-lactam immediate-type hypersensitivity reactions

A new option for the treatment of anaphylaxis linked to steroidal neuromuscular blockers: How much value should we grant to case reports?

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