1/51. Anaphylactoid reaction to adenosine.adenosine (Adenocard) is an endogenous purine nucleoside that has been approved recently for intravenous treatment of paroxysmal supraventricular tachycardia. With a serum half-life of 10 seconds, reported side effects including facial flushing, dyspnea, and chest pressure are common, but very transient. An elderly woman who received adenosine for paroxysmal supraventricular tachycardia had a prolonged anaphylactoid reaction that required pharmacological treatment. This is the first reported case of a prolonged anaphylactoid reaction to adenosine.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/51. Cerebral perfusion monitored using transcranial Doppler during acute anaphylaxis.We present a case of severe acute anaphylaxis that occurred during preparation of a patient for carotid endarterectomy. Intra-arterial blood pressure and transcranial Doppler monitoring had been established before the anaphylactic reaction began and therefore the changes in arterial blood pressure and middle cerebral artery blood-flow velocity could be observed as they happened. This made it possible to assess directly the effectiveness of our management, which followed the resuscitation guidelines issued by the association of Anaesthetists. In particular, this was a rare opportunity to confirm whether the recommended management is effective in restoring cerebral blood flow, and not just blood pressure, in a 'real life' situation, as most resuscitation information is based on laboratory-based animal studies. Evidence is presented which suggests that the administration of adrenaline in this setting is associated with increases in cerebral blood flow that are independent of arterial blood pressure.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
3/51. latex anaphylaxis causing heart block: role of ranitidine.PURPOSE: Treatment with H2 receptor antagonists may cause the heart to be more susceptible to atrioventricular conduction delay when exposed to an overwhelming insult by histamine released during an anaphylactic reaction. We present the case of a woman, pretreated with ranitidine, who developed 3:1 heart block secondary to latex anaphylaxis. We propose that H2 antagonist premedication alone in patients susceptible to anaphylaxis increases their risk of heart block. CLINICAL FEATURES: A 38 yr old obese woman with cervical cancer presented for a radical hysterectomy. Systems review yielded a history of sleep apnea, orthopnea, gastroesophageal reflux, and sciatica. Medications included preoperative ranitidine, 150 mg. There was no history of atopy or allergy. Following general anesthesia induction, at the onset of the surgical procedure the patient developed a severe anaphylactic reaction which was heralded by the onset of 3:1 heart block, with decreases in SpO2, P(ET)CO2 and a decrease in systolic blood pressure to 45 mmHg. This was diagnosed as a possible latex reaction and treated using epinephrine boluses and infusion, fluids, 50 mg diphenhydramine, 50 mg ranitidine and 100 mg hydrocortisone. Following a 48 hr stay in the ICU the patient made an uneventful recovery. Allergy testing with intradermal latex injection and increased plasma tryptase levels confirmed a latex anaphylaxis. CONCLUSION: The use of H2 antagonists alone as a prophylaxis for gastroesophageal reflux may increase the risk of heart block in patients who develop anaphylaxis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/51. Life-threatening reaction to vancomycin given for noninfectious fever.OBJECTIVE: To report a case of vancomycin-induced anaphylaxis (or anaphylactoid reaction) in a patient with a fever of unrecognized noninfectious origin. CASE SUMMARY: An 83-year-old white man, who was a patient of the veterans Affairs Medical Center, developed a serious anaphylactic (or anaphylactoid) reaction while receiving intravenous vancomycin as empiric therapy for a nosocomial fever of unknown origin. The fever was subsequently proved to have been due to acute polyarticular gout rather than an infection. DISCUSSION: This patient developed respiratory distress and an increased serum troponin concentration, suggestive of a myocardial enzymatic leak as a result of vancomycin therapy. Vancomycin was given before the noninfectious cause of his fever was recognized. CONCLUSIONS: Even with cautious slow infusion, intravenous vancomycin can precipitate life-threatening infusion-related reactions in some patients. Because of this, and to reduce selective pressure for vancomycin resistance, sources of fever that do not require treatment with vancomycin should be diligently investigated prior to the institution of empiric vancomycin therapy in febrile patients, particularly when the past medical history is suggestive of an alternative diagnosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/51. Anaphylactic reactions to proton-pump inhibitors.OBJECTIVE: To report two cases of anaphylactic reactions to proton-pump inhibitors (PPIs). CASE SUMMARIES: A 54-year-old woman who had taken omeprazole in the past was treated with omeprazole 40 mg and developed periorbital edema, edema of the skin, pruritus, nausea, and vomiting about 45 minutes after taking one capsule. Five months later, she was treated with lansoprazole 30-mg capsules. Again, within 45 minutes she developed an even more serious reaction, with pruritus and urticaria on her whole body, increased sweating, facial edema, and loss of consciousness. A 61 -year-old man took one tablet of pantoprazole 40 mg one year after first being treated with the drug. Within hours after ingestion, he developed malaise, generalized pruritus and urticaria, a swollen tongue and eyes, and diffuse sweating; his blood pressure decreased to 75/50 mm Hg. DISCUSSION: Because of the acute onset of symptoms and close temporal association with exposure to the drug, as well as previous exposure to it, the reactions can be classified as anaphylactic shock to PPIs. These benzimidazole derivatives are chemically related; observations in a few patients, such as the first case above, suggest that cross-sensitivity may occur. The Uppsala Monitoring Centre (UMC) has received a total of 42 reports of anaphylactic reactions or anaphylactic shock in association with PPIs. These reports account for 0.2% of the total of reported suspected adverse drug reactions to PPIs, compared with 0.8% anaphylactic reactions in the UMC database as a whole. CONCLUSIONS: These findings suggest that the chemically related PPIs can, as a group, cause anaphylactic reactions; however, the rate is comparatively low. Since anaphylaxis is a potentially serious reaction, more precise information is needed regarding its frequency, and healthcare professionals need to be aware of this possibility when prescribing these agents.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/51. Rocuronium anaphylaxis and multiple neuromuscular blocking drug sensitivities.PURPOSE: To report a case of anaphylaxis to rocuronium and the sensitivities to multiple neuromuscular blocking drugs in a patient with no previous exposure to this group of drugs. We describe the current recommendations for both intraoperative and postoperative testing of these patients. CLINICAL FEATURES: A 36-yr-old man was admitted for repair of a ruptured achilles tendon. Following induction of general anesthesia with fentanyl and propofol, 60 mg of rocuronium were given to facilitate tracheal intubation. He immediately became profoundly hypotensive with impalpable pulses, and blood pressure could not be recorded. Airway pressure increased markedly, and hand ventilation of the lungs became very difficult. His airway was secured and he was successfully resuscitated with 3 mg epinephrine and three litres crystalloid and colloid intravenous fluid therapy. His recovery in the intensive care unit was uneventful and the operation was performed four days later under spinal anesthesia. Subsequent skin prick testing, performed six weeks later, demonstrated strong positive weal and flare reactions to rocuronium, vecuronium and pancuronium, and some cross-reactivity with the benzylisoquinolinium group of muscle relaxants. CONCLUSION: Muscle relaxants are responsible for 61.6% of cases of anaphylaxis during general anesthesia. Cross-reactivity is common, as this group of drugs share a quaternary ammonium group. It is mandatory that patients be tested for both the agent responsible and cross-reactivity following an anaphylactic response. We suggest a protocol for investigation of suspected anaphylaxis.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/51. IgE-mediated anaphylaxis after first intravenous infusion of cyclosporine.BACKGROUND: Intravenous administration of cyclosporine, which contains Cremophor EL (a polyethoxylated castor oil; BASF, berlin, germany), has occasionally resulted in an anaphylactic reaction. An apparent hypersensitivity reaction (bronchospasm and decrease in blood pressure) had occurred during heart transplantation in a 59-year-old woman after intravenous infusion of cyclosporine. Subsequent oral administration of cyclosporine precipitated no reaction. OBJECTIVE: The purpose of this study was to attempt to ascertain the mechanism responsible for the anaphylactic reaction. methods: hypersensitivity investigations, including total serum IgE and allergen-specific IgE quantifications, skin testing, and basophil activation tests by flow cytometric determination of CD63 upregulation were undertaken in the study patient and in two healthy control subjects who were free of medication. RESULTS: The results of intradermal testing with Cremophor EL were positive after 15 minutes in the study patient only. Both cyclosporine and Cremophor EL induced considerable activation of the basophils from our study patient, with an upregulation of CD63 expression from 1% to 39% and 55%, respectively. In contrast, the expression of CD63 on basophils from the two control subjects remained essentially unchanged. CONCLUSIONS: The negative investigative findings in the control subjects, the patient's clinical manifestations in temporal relationship to the infusion, her positive results on intradermal testing with Cremophor, the basophil activation test results, and her uneventful course after oral administration of cyclosporine strongly support the presence of IgE antibodies to Cremophor EL in our patient.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/51. Effects of losartan on blood pressure and humoral factors in a patient who suffered from anaphylactoid reactions when treated with ACE inhibitors during LDL apheresis.In a patient who was taking an angiotensin-converting-enzyme inhibitor, low-density lipoprotein (LDL) apheresis with dextran-sulfate cellulose provoked hypotension accompanied by lacrimation and blurred vision. hypotension was eliminated by changing the anticoagulant from heparin to a protease inhibitor, nafamostat mesilate. A study was undertaken to clarify whether an antagonist of angiotensin type 1-receptor, losartan, could be safely used in the same patient during LDL apheresis treatment. blood pressure and humoral factors were compared between the apheresis sessions with losartan and those without. Although angiotensin ii and bradykinin plasma levels during LDL apheresis were significantly greater with losartan than without, blood pressure reduction by losartan was mild and unpleasant symptoms were not induced. losartan was thus safely used for this patient during treatment by LDL apheresis. The greater rise in bradykinin levels during apheresis with losartan might be ascribable to angiotensin type 2-receptor stimulation.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
9/51. fluid therapy in severe systemic reaction to radiopaque dye.Two patients developed severe vascular collapse after left ventriculography with organic iodides. Hemodynamic monitoring showed marked reduction in systemic pressures. In one patient there was no response to the standard therapeutic measures in anaphylactic reactions, and prompt response to fluid administration was obtained. In the second patient response was prompt to fluids, adrenalin, and hydrocortisone.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/51. anaphylaxis to rocuronium.Reports about anaphylactic and anaphylactoid reactions to rocuronium have increased recently. We report two new cases of documented grade III anaphylaxis, leading to death in one patient. The first case occurred in an 81-year-old ASA II woman scheduled for emergency abdominal surgery. Severe hypotension and tachycardia were observed after rocuronium, without bronchospasm. Neosynephrine allowed rapid resuscitation, and the patient recovered fully. The second patient was a 64-year-old ASA II man scheduled for abdominal surgery. Severe haemodynamic instability and bronchospasm occurred after rocuronium. Despite immediate life support, the postoperative period was complicated by persistent low systolic pressure, acute respiratory distress syndrome, acute renal failure, disseminated intravascular coagulation and pancreatitis, leading to the death of the patient.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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