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

By Jerrold H. Levy

This ebook presents anaesthetists with a pragmatic method of the popularity, realizing, and administration of life-threatening reactions to anaesthesia and different medicinal drugs used in the course of surgical procedure and within the ICU.

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Additional info for Anaphylactic Reactions in Anesthesia and Intensive Care

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T h e y noted a significant decrease in systolic, diastolic, and mean aortic pressure, systemic vascular resistance, left ventricular end-diastolic pressure, and stroke index and a significant increase in heart rate, cardiac output, and left ventricular dP/dT m a x (Table 3 . 4 ) . T h e r e were n o significant changes in mean pulmonary artery pressure or pulmonary vascular resistance. Plasma norepinephrine but not epinephrine increased significantly. All o f the hemodynamic changes started 1 to 2 minutes after the onset o f the histamine infusion and returned to baseline within 5 minutes after discontinuation.

STORED MEDIATORS Histamine Biochemistry Histamine is an imidazolylethylamine with a molecular weight o f 1 1 1 daltons. , 1 9 8 2 ) . 1 Biologic Actions and Clinical Manifestations of Mast Cell/Basophil Mediators Mediators Biologic Actions Manifestations Histamine Smooth muscle relaxation Smooth muscle contraction Increases capillary permeability Positive inotropic Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Angioedema, urticaria, efflux of inflammatory cells Increased myocardial contractility Tachycardia Positive chronotropic ECF-A Eosinophil chemotaxis Inflammation NCA Neutrophil chemotaxis Inflammation Neutral proteases Proteolysis Inflammation Heparin Anticoagulant Coagulopathy Smooth muscle relaxation Smooth muscle contraction Stimulates mucus secretion Enhances basophil mediator release Inhibits platelet aggregation Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Broncho/rhinor rhea Potentiates reactions Leukotrienes (C 4, D 4, E 4) Smooth muscle relaxation Smooth muscle contraction Increases capillary permeability Stimulates mucus secretion Negative inotropic Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Angioedema, urticaria, efflux of inflammatory cells Broncho/rhinorrhea Myocardial depression, hypotension PAF Smooth muscle relaxation Smooth muscle contraction Increases capillary permeability Negative inotropic Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Angioedema, urticaria, efflux of inflammatory cells Myocardial depression, hypotension Neutrophil activation Platelet activation Newly synthesized Prostaglandin D 2 Neutrophil aggregation Platelet aggregation Not known ECF-A = eosinophilic chemotactic factor of anaphylaxis; GI = gastrointestinal; NCA = neutrophilic chemotactic factor; PAF = platelet-activating factor.

Histamine produces vascular responses that are the result of multiple actions on the smooth muscle and endothelium (right), which are manifested as vascular relaxation or contraction (left). H! receptor stimulation of vascular smooth muscle produces vascular contraction, whereas H 2 receptor stimulation produces relaxation. Stimulation of endothelial H 2 receptors releases endothelium-derived relaxing factor (EDRF) (which derives from L-arginine by the action of nitric oxide synthetase) or prostacyclin (PGI 2).

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