Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1981
The epidemiology and clinical features of anaphylactic reactions in anaesthesia.
Severe anaphylactoid reactions during anaesthesia in 116 patients are described. The majority of patients who reacted to induction agents had previous exposure to the drug, while the majority of patients who reacted to muscle relaxants had not. There was a statistically significant increased incidence of allergy, atopy, asthma and previous reactions in patients who had reactions compared with a control group undergoing uneventful anaesthesia. ⋯ No one drug produced reactions that differed in severity or clinical features from any other drug. Clinical features included skin changes, oedema, cardiovascular collapse, bronchospasm, gastrointestinal symptoms, prolonged unconsciousness, convulsions and pulmonary oedema. Four patients died.
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Anaesth Intensive Care · Aug 1981
The diagnosis of acute anaphylactoid reactions to anaesthetic drugs.
Patients with a presumptive diagnosis of an acute anaphylactoid reaction to anaesthesia were investigated to determine the cause of the reaction and the drug responsible by intradermal testing, patch and prick testing, sequential complement measurement, passive transfer testing and challenge. The most valuable information was provided by intradermal testing and a diagnosis could be made in 150 of 165 patients. When analphylactoid reactions to anaesthetic drugs occur, intradermal testing one month after the reaction and sequential complement measurements in the immediate post reaction period will enable the diagnosis to be established in the majority of cases. Intradermal testing is of no value for trivial reactions or reactions to colloid solutions or contrast media.
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Protamine hypersensitivity has been documented by intra-dermal skin testing in three patients who demonstrated sudden cardiovascular collapse and bronchospasm following the use of intravenous protamine sulphate. All patients had been given protamine previously. ⋯ Intra-dermal skin testing against all anaesthetic agents is recommended so that the specific allergen can be identified. In patients who are shown to be allergic to protamine sulphate and who require cardiac or vascular surgery careful monitoring of heparin dosage and neutralisation with hexadimethrine (Polybrene) intravenously appears to be a safe alternative.
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Anaesth Intensive Care · May 1981
Comparative StudyThe effect on heart rate of neuromuscular blockade reversal by pyridostigmine.
Pyridostigmine without atropine, pyridostigmine with atropine or neostigmine with atropine were used to antagonise neuro-muscular blockade induced by d-tubocurarine in forty otherwise healthy, female patients recovering from gynaecological surgery. Pulse rates fell significantly (P less than 0.01, control heart rate 72 +/- 18 beats/min (M +/- SD) to 55 +/- 13 beats/min) at ten minutes after pyridostigmine (10 mg/70 kg), necessitating administration of atropine (1.25 mg/70 kg) by fifteen minutes after pyridostigmine. ⋯ It was concluded that pyridostigmine should not be given alone, but requires the use of atropine to prevent bradycardia. This combination may, however, provide a more stable heart rate than that seen with neostigmine and atropine in usual doses, when these drugs are used to antagonise d-tubocurarine.