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澳大利亚纽卡斯尔麻醉相关过敏反应调查程序综述。

Review of procedures for investigation of anaesthesia-associated anaphylaxis in Newcastle, Australia.

作者信息

McNeill O, Kerridge R K, Boyle M J

机构信息

Department of Immunology, John Hunter Hospital, Newcastle, New South Wales, Australia.

出版信息

Anaesth Intensive Care. 2008 Mar;36(2):201-7. doi: 10.1177/0310057X0803600210.

Abstract

The procedures, results and outcomes of investigation of 50 patients with clinical episodes of anaesthesia-associated anaphylaxis were retrospectively reviewed. Assessment was performed by measurement of serum tryptase and specific IgE and a combination of skin prick and intradermal skin testing. Testing was performed both for agents received during the anaesthetic and for agents the patient may encounter in future procedures. Twenty of 50 patients underwent a subsequent procedure after assessment. Sensitisation to neuromuscular blocking agents was identified in 18 patients (36%). Sensitisation to propofol (14 patients; 28%) and latex (four patients; 8%) was also frequently identified. No precise cause was identified in 11 cases (22%). Reactivity to more than one agent was identified in 14 patients (28%). Serum tryptase was measured within six hours of the episode in only 28 of the 50 cases. All the patients with elevated serum tryptase had clinically severe reactions. One patient initially found to be sensitised to propofol had another reaction during a second procedure, prompting further assessment where chlorhexidine reactivity was identified. Subsequent surgery in that patient and in 19 other patients where agents implicated in the testing were avoided, proceeded without incident. The results reaffirm that neuromuscular blocking agents are the most common cause of anaphylaxis during anaesthesia. The importance of serum tryptase measurement at the time of the acute episode needs to be emphasised. Investigation should include screening for chlorhexidine and latex in all patients, as exposure to both these agents is common and may be overlooked.

摘要

对50例发生麻醉相关过敏反应临床发作的患者的检查过程、结果及转归进行了回顾性分析。通过检测血清类胰蛋白酶和特异性IgE以及联合进行皮肤点刺试验和皮内试验进行评估。对麻醉期间使用的药物以及患者在未来手术中可能接触到的药物均进行了检测。50例患者中有20例在评估后接受了后续手术。18例患者(36%)被确定对神经肌肉阻滞剂致敏。对丙泊酚(14例患者;28%)和乳胶(4例患者;8%)致敏的情况也较为常见。11例病例(22%)未明确具体病因。14例患者(28%)被确定对不止一种药物有反应。50例病例中仅有28例在发作后6小时内检测了血清类胰蛋白酶。所有血清类胰蛋白酶升高的患者均有临床严重反应。1例最初被确定对丙泊酚致敏的患者在第二次手术期间再次发生反应,促使进一步评估,结果确定其对氯己定有反应。该患者以及另外19例避免使用检测中涉及药物的患者随后进行的手术均顺利完成。结果再次证实神经肌肉阻滞剂是麻醉期间过敏反应最常见的原因。需要强调急性发作时检测血清类胰蛋白酶的重要性。所有患者的检查均应包括对氯己定和乳胶的筛查,因为接触这两种药物的情况很常见且可能被忽视。

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