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Anaphylactic Reactions in Anesthesia and Intensive Care by Jerrold H. Levy

By Jerrold H. Levy

This booklet offers anaesthetists with a realistic method of the popularity, knowing, and administration of life-threatening reactions to anaesthesia and different medicines used in the course of surgical procedure and within the ICU

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Extra resources for Anaphylactic Reactions in Anesthesia and Intensive Care

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410·408 The exact role of the eosinophil or eosinophilic chemotactic factor of anaphylaxis in the allergic response is not clear. 337 These enzymes can inactivate histamine and leukotrienes. 348 Heparin Heparin, a proteoglycan ionically bound to histamine in granules, is stored in human lung and cutaneous mast cells. 250 Heparin used in clinical practice is derived from both cow and pig lungs because of its high mast cell content. 14,245·286 Two major classes of arachidonic acid metabolites are (1) cyclooxygenase products: prostaglandins, thromboxanes, and prostacyclin and (2) lipoxygenase products: leukotrienes.

43·307 H 2 -receptor stimulation on mast cells inhibits activation, similar to ß 2 -adrenergic receptor stimulation. 38 · 43 H 2 -receptor stimulation also inhibits T-cell lymphocyte function. 3). 307 140 ng/ml have been reported during human anaphylaxis. 263,368 Physiologic effects vary depending on the status of the patient. For example, an intravascular-volume-depleted patient is profoundly sensitive to the hypotensive effects of histamine release. In a fascinating study, Vigorito et al. administered exogenous histamine in four patients undergoing diagnostic cardiac catheterization to study the hemodynamic effects of histamine.

ANESTHETIC AGENTS Induction Agents All intravenous induction agents have been implicated in producing life-threatening allergic reactions. 413-414 Clark reported that reactions were most common with propanidid (Epontol) and alphaxalone/alphadolone (Althesin). 68 However, thiopental has been reported. 246 The major intravenous anesthetic induction agents are considered separately. Barbiturates Over 290 cases have been reported regarding anaphylactic or anaphylactoid reactions to barbiturates. 220 Of the 268 reported cases of thiopental reactions, detailed case presentations were available for 185.

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