Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Reg Anesth Pain Med. 2019 Jan;44(1):118-121. doi: 10.1136/rapm-2018-000012.
In patients with a history of a hypersensitivity reaction to iodinated contrast medium, iodinated contrast medium is avoided, antihistamine and steroid premedication are given, or a gadolinium-based contrast agent is employed. Six patients with a history of a hypersensitivity reaction to iodinated contrast medium and who were not premedicated had an unintentional injection of iodinated contrast. None of the patients developed a moderate or severe reaction. All patients had gadopentetate dimeglumine in one of their injections; three had repeated injections of the gadopentetate. The lack of a significant reaction may be due to any or all of the following: questionable history of iodinated contrast reaction, low dose of iodinated contrast given, concomitant injection of (epidural) steroid, and slower absorption from epidural compared with intravenous injection. While it is reassuring to know that there is a low possibility of a moderate to severe reaction in these patients, every effort should be made to avoid this scenario, appropriate drugs and resuscitation equipment should be immediately available, and the patients should be observed adequately and followed for the possibility of late reactions. Recent publications have called for caution in the use of gadolinium-based contrast agents.
对于有碘对比剂过敏史的患者，避免使用碘对比剂，给予抗组胺药和皮质类固醇预处理，或使用基于钆的造影剂。六名有碘对比剂过敏史且未进行预处理的患者意外注射了碘对比剂。没有患者发生中度或重度反应。所有患者均在一次注射中使用了钆喷替酸葡甲胺；有三人重复使用了钆喷替酸。没有发生明显反应可能归因于以下任何一个或多个因素：碘对比剂反应的可疑病史、给予的碘对比剂剂量低、同时注射（硬膜外）皮质类固醇，以及与静脉注射相比，从硬膜外吸收较慢。虽然了解到这些患者发生中度至重度反应的可能性较低令人放心，但应尽一切努力避免这种情况，应立即提供适当的药物和复苏设备，并充分观察患者并随访是否有迟发性反应的可能。最近的出版物呼吁谨慎使用基于钆的造影剂。
