By Jerrold H. Levy

This publication offers anaesthetists with a pragmatic method of the popularity, figuring out, and administration of life-threatening reactions to anaesthesia and different medications used in the course of surgical procedure and within the ICU

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Anaphylactic Reactions in Anesthesia and Intensive Care

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Extra resources for Anaphylactic Reactions in Anesthesia and Intensive Care

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Clinical manifestations of suspected allergic reactions, although attributed to direct toxic, pharmacologie, or anesthetic effects, often go unreported. Most anesthetic agents cause dose-related depression of the cardiovascular system by direct and indirect effects. Bronchospasm may occur during laryngoscopy and intubation under light planes of anesthesia. Urticaria and hypotension often occur following rapid administration of narcotics, d-tubocurarine, or vancomycin. An immunologie mechanism for most clinically suspected immediate hypersensitivity reactions during anesthesia is difficult to prove.

Why some patients develop isolated localized cutaneous reactions or bronchospasm while others have cardiovascular collapse or a full-blown syndrome is not clear. The agents most likely to cause anaphylactic and anaphylactoid reactions while the patient is under anesthesia or in the intensive care unit are antibiotics, blood products, colloid volume expanders, succinylcholine, or thiobarbiturates. The Boston Collaborative Drug 53 54 Management of Anaphylaxis Surveillance Program recorded eight cases of anaphylaxis in a series of 11,526 consecutively monitored medical in-patients.

One patient progressed from first- to third-degree atrioventricular block during the infusion but recovered after it was stopped. The authors attributed the cardiovascular changes to an increase in sympathoadrenergic activity and a direct effect of histamine. 5 3 2 335 103 26 2 2 34 30 Values expressed as mean ± standard deviation. Abbreviations used: LVEDP, left ventricular end-diastolic pressure; LV dP/dTmax, maximum rate of rise of left ventricular pressure. Data from Vigorito et al. 402 Mediators of Anaphylactic Reactions 33 Metabolism Histamine is rapidly metabolized by tissue enzymatic pathways.

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