1/25. Persistent anaphylactic reaction after induction with thiopentone and cisatracurium.A 6-year-old boy presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 microg. kg(-1) x min(-1) was necessary to break the severe refractory bronchial hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no definite family history of allergy. Through increased serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated anaphylactic reaction to cisatracurium in the child's first exposure to this new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in children. The pathogenesis, diagnosis and management of life threatening persistent allergic reactions to intravenous anaesthetics are discussed.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/25. Immediate reaction to clarithromycin.We present the case of bronchospastic reaction to clarithromycin had during a drug challenge test. Personal allergic history was negative for respiratory allergies and positive for adverse drug reactions to general and regional anesthesia and to ceftriaxone. After the administration of 1/4 of therapeutic dose of clarithromycin the patient showed dyspnea, cough and bronchospasm in all the lung fields. The positivity of the test was confirmed by the negativity to the administration of placebo. The quickness and the clinical characteristic of the adverse reaction suggest a pathogenic mechanism of immediate-type hypersensitivity. On reviewing the literature we have found no reports of bronchospastic reaction to clarithromycin. macrolides are a class of antibiotics mainly used in the last years in place of beta-lactams because of a broad spectrum of action and a low allergic power. In fact, there are few reports on allergic reactions to these molecules. clarithromycin is one of the latest macrolides, characterised by the presence of a 14-carbon-atom lactone ring as erythromycin, active on a wide spectrum of pathogens.- - - - - - - - - - ranking = 0.66666666666667keywords = drug (Clic here for more details about this article) |
3/25. Bronchospasm induced by propofol in a patient with sick house syndrome.IMPLICATIONS: propofol is often used in patients with asthma, but it can induce bronchospasm. We report a patient with sick house syndrome (nonspecific complaints of mucosal irritation, headache, nausea, and chest symptoms) who suffered bronchospasm. This case suggests that propofol is not always a safe anesthetic for patients with asthma, especially drug-induced asthma.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
4/25. The management of agitation in demented patients with propranolol.Congress and the FDA have strongly suggested that tranquilizers and antipsychotics not be used in agitated demented frail elderly patients. The medical profession has not moved away from the tradition of antipsychotic sedation of such patients. Use of 'modern second generation low dose' antipsychotics continue to be the standard of care. propranolol, a non-selective beta-blocker with good penetration of the CNS, is a reasonable and safe alternative to sedatives and antipsychotics. Anti-dementia drugs are complementary to propranolol. A case study which contrasts the two pharmacologic approaches is detailed. A method of estimating delirium-agitation risk in dementia patients (DRN method) is described.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
5/25. isoflurane therapy for status asthmaticus in children and adults.Two adults and two children with life-threatening asthma refractory to maximal standard therapy were treated with the inhalational anesthetic agent isoflurane. In each case, the temporal response to the initiation of therapy was striking. All patients survived and none experienced adverse reactions attributable to the drug. Rapid therapeutic benefit, minimal side effects, absence of cumulative toxicity, and ease of administration are factors supporting the use of isoflurane for patients with severe asthma.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
6/25. Fatal asthma in a subject sensitized to toluene diisocyanate.We report the case of a 43-yr-old car painter who died within 1 h of exposure to a polyurethane paint in the workplace. A diagnosis of asthma induced by toluene diisocyanate (TDI) had been established 6 yr before, when he underwent inhalation challenges with carbachol and with TDI. The subject had airway hyperresponsiveness to carbachol (PD20FEV1 carbachol = 0.32 mg; normal value greater than 1.0 mg) and developed an early and long-lasting asthmatic reaction after exposure to TDI in the laboratory. Although it was recommended that he change his job or stop using paints containing isocyanates, he continued to work as a car painter, taking antiasthmatic drugs both at work and at home to control asthma symptoms. On Monday, October 6, 1986, at 11:30 A. M., he developed a severe attack of asthma while he was mixing the 2 components of a polyurethane paint. Taken to hospital, he was dead on arrival. autopsy showed no evidence of cardiac or brain disease; lungs were overinflated, the cut surface showed grey glistening mucous plugs in in the airways. Histologic examination showed denudation of airway epithelium and thickening of the basement membrane with infiltration of the lamina propria by polymorphonuclear leukocytes, mainly eosinophils, and diffuse mucous plugging of bronchioles. Bronchial smooth muscle appeared hyperplastic and disarrayed, and lung parenchyma showed focal areas of alveolar destruction adjacent to areas of perfectly intact alveolar walls.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
7/25. Sensitivity to non-acetylated salicylates in a patient with asthma, nasal polyps, and rheumatoid arthritis.A woman experienced exacerbations of bronchial asthma after taking aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. On oral challenges, she developed an urticarial reaction after tartrazine; urticarial and bronchospastic reactions after salicylsalicylic acid; and urticarial and bronchospastic reactions after choline magnesium trisalicylate. Non-acetylated salicylates have been recommended for use in aspirin- and/or tartrazine-sensitive patients. The results of sensitivity studies of our patient indicates that such patients may also be sensitive to non-acetylated salicylates.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
8/25. Bronchospasm during cardiopulmonary bypass. Etiology and management.Severe bronchospasm occurring after extracorporeal circulation is an unusual event. We report three such cases. Possible etiologies include activation of complement anaphylatoxins during cardiopulmonary bypass, cardiac asthma, cold urticaria syndrome, exacerbation of preoperative bronchospastic disease, allergic reactions, drug-induced histamine release and beta-adrenergic blockade induced bronchospasm. The management and treatment of patients with this complication is reviewed.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
9/25. Systemic anaphylaxis induced by physical exertion: a case report.anaphylaxis is a systemic reaction which can be very dangerous in many patients. In addition to the most common antigens (drugs, venoms, foods), physical exercise can provoke anaphylaxis in the sensitized patients. The mechanism of this reaction is still unknown. In this report, we describe a case of exercise-induced anaphylaxis in a 25 year old female who had experienced two syncopal attacks during strong physical activity. On other occasions she had noticed that prolonged work would cause urticaria, pruritus and numbness. During hospitalization, on two occasions a treadmill stress test induced bronchial spasm, urticaria and hypotension. We believe that the association of urticaria and anaphylaxis would suggest the possible presence of a vasoactive substance released from the mast-cells and basophil leucocytes.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
10/25. etoposide-induced hypersensitivity reactions. Report of two cases.Two cases of hypersensitivity reactions following etoposide infusion are reported, occurring in patients not previously exposed to the drug. In both cases, bronchospasm and diffuse skin flushing were the associated clinical findings. The present experience does not confirm the previous report by O'Dwyer and Weiss, who inferred the existence of two distinct clinical patterns in such patients, with either bronchospasm or flush. Type I hypersensitivity must be regarded as a possible acute adverse effect of etoposide infusion therapy, but more research seems necessary to elucidate the pathophysiology of this phenomenon.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
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