Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study

Mertès, Paul-Michel; Petitpain, Nadine; Tacquard, Charles; Delpuech, Marion; Baumann, Cédric; Malinovsky, J. M.; Longrois, Dan; Gouel-Cheron, Aurélie; Quang, Diane Le; Demoly, Pascal; Guéant, Jean Louis; Gillet, Pierre; Aguinet, Emmanuelle; Apoil, P.A.; Autegarden, Jean Eric; Bettayeb, Faiza; Biermann, Céline; Bordes-demolis, Maryline; Chiriac, Anca Mirela; Darene, Pierre Antoine; Deblay, Frédéric; Dessard, Sabrina; Dzviga, C.; Hanache, H. El; Facon, A.; Fuhrer, Yannick; Gest, Noémie; Gouitaa, M.; Harpan, Adela; Hoarau, C.; Guillou, Lisa Le; Lepeltier, Laurence; Mailhol, C.; Mariotte, D.; Meunier, Yannick; Migueres, Isabelle; Morisset, M.; Neukirch, Catherine; Nouar, D.; Ollivier, Yann; Orsel, Isabelle; Outtas, Omar; Patel, Minaxi; Pellerin, C.; Petit, Isabelle; Pipet, A.; Rochefort-Morel, C.; Schwartz, Claire; Seltzer, S.; Seringulian, Alice; Soria, Angèle; Soufir, Lilia; Stenger, Richard J.; Tummino, C.; Verdaguer, Maties Ramisa

doi:10.1016/j.bja.2023.02.026

Cited by 15 publications

(3 citation statements)

References 25 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple logistic regression was used to adjust for potential confounders to obtain the adjusted OR and 95% CI. 13 The ROC curve was plotted and the area under the curve was calculated. All statistical analyses were performed using R software (R version 4.1.2) and SPSS (Version 20.0; IBM Statistics, Armonk, NY).…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Distant Metastasis in T3 T4 Rectal Cancer

Tang,

Xu,

Lin

et al. 2024

Clin Med Insights Oncol

View full text Add to dashboard Cite

Background: Distant metastasis is the leading cause of death in patients with rectal cancer. This study aims to comprehensively analyze the risk factors of distant metastasis in T3 T4 rectal cancer using magnetic resonance imaging (MRI), pathological features, and serum indicators. Methods: The clinicopathological data of 146 cases of T3 T4 rectal cancer after radical resection from January 2015 to March 2023 were retrospectively analyzed. Pre- and postoperative follow-up data of all cases were collected to screen for distant metastatic lesions. Univariate and multivariate Logistic regression methods were used to analyze the relationship between MRI features, pathological results, serum test indexes, and distant metastasis. Results: Of the 146 included patients, synchronous or metachronous distance metastasis was confirmed in 43 (29.4%) cases. The patients’ baseline data and univariate analysis showed that mrEMVI, maximum tumor diameter, mr T Stage, pathological N stage, number of lymph node metastasis, cancer nodules, preoperative serum CEA, (Carcinoembryonic antigen) and CA199 were associated with distant metastasis. In the multiple logistic regression model, mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter, and preoperative serum CEA were identified as independent risk factors for distant metastasis: mrEMVI [odds ratio (OR) = 3.06], pathological N stage (OR = 6.52 for N1 vs N0; OR = 63.47 for N2 vs N0), preoperative serum CEA (OR = 0.27), tumor maximum diameter (OR = 1.03), number of lymph nodes metastasis (OR = 0.62). And, the receiver operating characteristic (ROC) curve was plotted and the area under the curve was calculated (area under the curve [AUC) = 0.817, 95% CI = 0.744-0.890, P < .001]. Conclusions: mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter and preoperative serum CEA are the independent risk factors for distant metastasis in T3 T4 rectal cancer. A comprehensive analysis of the risk factors for distant metastasis in rectal cancer can provide a reliable basis for formulating individualized treatment strategies, follow-up plans, and evaluating prognosis.

show abstract

Section: Methodsmentioning

confidence: 99%

Risk Factors for Distant Metastasis in T3 T4 Rectal Cancer

Tang,

Xu,

Lin

et al. 2024

Clin Med Insights Oncol

View full text Add to dashboard Cite

show abstract

“…The screening of patients for pholcodine use prior to the planned administration of an NMBA is not recommended, and patients who report pholcodine use should still receive an NMBA if this is clinically indicated. The impact of pholcodine withdrawal on incidence of NMBA allergy will be evaluated over the coming years [62][63][64].…”

Section: Avoiding Future Reactionsmentioning

confidence: 99%

Management and treatment of perioperative hypersensitivity

Littlejohns,

Savic

2024

Current Opinion in Allergy &Amp; Clinical Immunology

View full text Add to dashboard Cite

Purpose of review Perioperative hypersensitivity reactions are rare but potentially catastrophic events. This review acts to summarize recent recommendations for both immediate and poststabilization management of suspected reactions, alongside practical advice for anaesthetists who may be faced with these events. Recent findings Prompt treatment is essential but may be hampered by delay in recognition. This can occur because there are multiple differential diagnoses for the observed clinical signs as well as variations in clinical presentation. Resuscitation is dependent on the use of adrenaline and fluids. Adrenaline should be administered in small, titrated intravenous boluses. Low-dose infusions should be commenced early if the response to boluses is poor. Large volume fluid resuscitation may be required to maintain adequate circulating volume. Chest compressions are recommended when there is evidence of inadequate perfusion, rather than waiting until cardiac arrest is confirmed. Antihistamines and corticosteroids are no longer recommended in the immediate management phase. Once the patient has been stabilized, it is important to obtain serial tryptase concentrations to aid the subsequent clinic investigation. The decision to proceed or abandon surgery will be based on an individual risk-benefit analysis. All cases of suspected perioperative hypersensitivity, including fatal cases, must be referred for formal investigation. Summary There have been recent updates to management guidelines in perioperative hypersensitivity. Treatment algorithms, treatment packs and referral packs can all help the anaesthetist manage these complex cases, aid the subsequent investigation and ensure patient safety in the future.

show abstract

“…Later in 2022, the European Medicines Agency (EMA) [ 7 ], the British government [ 8 ], and the World Health Organization (WHO) [ 9 ] issued reports highlighting the potential risk of perioperative anaphylactic shock associated with PHL use (up to 12 months prior to surgery) in combination with neuromuscular blocking agents [ 10 – 12 ]. This newly identified risk called the "ALPHO case study" [ 13 ], emphasizes the potential for serious adverse reactions beyond what was previously known. As a result, several markets have taken further steps to restrict PHL, either fully banning its OTC sale or requiring a prescription [ 7 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Voltammetric analysis of pholcodine on graphene-modified GNPs/PTs with green assessment

Abdelshafi,

Darwish,

Alanazi

et al. 2024

BMC Chemistry

View full text Add to dashboard Cite

Pholcodine, an anti-tussive medication widely used as an over-the-counter, OTC drug, has recently faced restrictions in several countries. This paper presents a sensitive electrochemical approach for pholcodine detection. The electrochemical method involved fabricating a graphene nanoplatelets electrode, incorporating polythiophene nanospheres polymer to promote electron transfer and increase the activated surface area. Characterization of the fabricated electrode was performed using transmission electron microscopy, ATR-Fourier-transform infrared spectroscopy, X-ray crystallography, X-ray photoelectron spectroscopy, and electrochemical impedance spectroscopy. The electrochemical behavior of pholcodine with the fabricated electrode was investigated using cyclic voltammetry, chronoamperometry, square wave voltammetry (SWV), and differential pulse voltammetry (DPV). The developed electrode led to a linear response for pholcodine ranging from 10 to 45 mg/L with detection limits of 1.41 and 1.51 mg/mL for SWV and DPV, respectively and quantification limits of 4.27 and 4.57 mg/L for SWV and DPV, respectively. The proposed method has accurately recovered pholcodine in spiked serum samples with a recovery percentage ranging from 1.2 to 2.9%. The optimized method is found to be accurate, precise, and robust by applying validation parameters provided by International Council for Harmonization. Two green metrics were computed to assess the method’s greenness, the findings showed that the developed method is environmentally friendly with minimum sample preparation steps.

show abstract

Pholcodine exposure increases the risk of perioperative anaphylaxis to neuromuscular blocking agents: the ALPHO case-control study

Cited by 15 publications

References 25 publications

Risk Factors for Distant Metastasis in T3 T4 Rectal Cancer

Risk Factors for Distant Metastasis in T3 T4 Rectal Cancer

Management and treatment of perioperative hypersensitivity

Voltammetric analysis of pholcodine on graphene-modified GNPs/PTs with green assessment

Contact Info

Product

Resources

About