Annales françaises d'anesthèsie et de rèanimation
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As diagnostic methods of detecting drug-specific IgE antibodies become more sophisticated, the evidence implicating specific IgE in anaesthetic allergy has increased. To implicate IgE in reactions, a history resembling anaphylaxis, the demonstration of drug-specific histamine release by intradermal testing and the demonstration of specific antibodies are necessary. Such evidence is seen in 70% of muscle relaxant reactors. Basophil histamine release studies suggest that histamine release is allergen-induced, not direct, and the final evidence necessary is to demonstrate the role of drug-specific antibodies in such histamine release.
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Ann Fr Anesth Reanim · Jan 1985
Comparative Study[Course of the neuromuscular block under atracurium. Comparison with alcuronium].
Using a standardized anaesthetic protocol, the continuous monitoring of the twitch height after a 0.1 Hz stimulus was used to follow the evolution of curarization following injection of either atracurium (0.6 mg . kg-1) or alcuronium (0.2 mg . kg-1). The maximum twitch height inhibition was always greater than 99% of the control value and occurred after 107 +/- 50 s with atracurium (n = 30) and 172 +/- 120 s for alcuronium (n = 30) (p less than 0.02). ⋯ The spontaneous return to normal of the train of four was also significantly longer (p less than 0.001) for alcuronium: 118 +/- 23 min (n = 10) versus 69 +/- 7 min for atracurium (n = 10). The recovery index (the time required for twitch height to rise from 25% to 75%) was three times quicker (p less than 0.01) for atracurium (10 +/- 3 min; n = 10) than for alcuronium (30 +/- 13 min; n = 10).(ABSTRACT TRUNCATED AT 250 WORDS)
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Intradermal testing is a valid manoeuvre for the determination of the drug responsible for an anaphylactoid reaction during anaesthesia. It does not fill criteria for a screening test and will have limited use in the preoperative diagnosis of anaesthetic allergy unless a high risk group is selected.