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

By Jerrold H. Levy

This ebook presents anaesthetists with a realistic method of the popularity, knowing, and administration of life-threatening reactions to anaesthesia and different medicines used in the course of surgical procedure and within the ICU

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In vitro IgE-mediated release of a prekallikrein activator has been demonstrated from human lung. 249 Purified human prekallikrein was converted to the active form (kallikrein) by lung 38 Mechanisms of Anaphylaxis protease. The kallikrein produced was shown to generate bradykinin from purified human high-molecular-weight kininogen. The prekallikrein activator provides a physiologic mechanism by which prekallikrein can be activated during anaphylaxis in man. Several processes independent of IgE can also generate kinins (see Chapter 4).

Of the 22 cases of methohexital reactions, 20 detailed cases occur in the literature. Cutaneous manifestations were present in 85 percent of cases, cardiovascular in 85 percent, respiratory in 55 percent, and gastrointestinal in 25 percent. Thiopental is most often implicated, accounting for 268 cases, while methohexital has also been described in 22 cases. 220 Hirshman has demonstrated dose-related histamine release from human cutaneous mast cells by thiamylal and thiopental, but not methohexital or pentobarbital at barbiturate concentrations from 10 " 5 to 10~ 3 molar, drug levels that can be observed in clinical use.

1):197·267 activation of the complement cascade (by IgG-antigen interactions, IgM-antigen interactions, or independent of antibodies), blood coagulation, fibrinolytic systems, the kinin-generating sequence, or pharmacologie release of histamine. Activation of any one of these systems may recruit other pathways to amplify the humoral effects. These processes have been called the humoral amplification systems. 1). Each pathway is considered. 1 A summary of the pathophysiologic changes producing anaphylactic and anaphylactoid reactions.

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