Seguimiento después de anafilaxis por anestesia |
Follow-up after anaesthetic anaphylaxis
M. M. FISHER, K. JONES and M. ROSE
Intensive Care Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia and Department of Anaesthesia and Pain Medicine, Royal North Shore Hospital of Sydney, Sydney, Australia
Acta Anaesthesiol Scand 2011; 55: 99-103
Background: The anaesthetic allergy clinic has been established at our institution for 30 years. Our practice has been to give patients a letter detailing the results of their investigations to pass on to subsequent anaesthetists. Our aims were to assess the adequacy of this letter in ensuring this vital communication, and to quantify the effectiveness of our recommendations on the safety of future anaesthesia. Methods: A project was undertaken to contact 606 previous clinic patients living in New South Wales by using last known addresses on our database, public telephone listing and local doctors. The review also involved collecting information, where available, about subsequent anaesthesia and the adequacy of information transfer about medications given safely or otherwise at this time. Results: Of 606 patients, 246 were contactable. Of these, 183 had been anaesthetised subsequently, all safely. It was found that in only 11 cases had the patient's clinic letter been updated with the information from subsequent anaesthesia. We updated the letters of 82 patients with new information to improve the safety of drug selection for future anaesthesia. Conclusions: Although clinic testing allowed a high degree of safety in subsequent anaesthesia, it is evident that there is a need for systems to be implemented to improve the flow of patient anaesthetic allergy information after subsequent anaesthesia.
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| Directrices. Reacciones anafilácticas sospechosas asociadas con anestesia |
GUIDELINES. Suspected Anaphylactic Reactions Associated with Anaesthesia.
Association of Anaesthetists of Great Britain and Ireland. Membership of the Working Party: N J N Harper, Chairman; T Dixon; P Dugue; D M Edgar; A Fay; H C Gooi; R Herriot; P Hopkins; J M Hunter; R Mirakian; R S H Pumphrey; S L Seneviratne; A F Walls; P Williams; J A Wildsmith; P Wood. Ex Officio: A S Nasser, R K Powell, R Mirakhur, J Soar, Executive Officers, AAGBI
British Society for Allergy and Clinical Immunology. Royal College of Anaesthetists, Resuscitation Council UK
This is a consensus document produced by expert members of a Working Party established by the Association of Anaesthetists of Great Britain and Ireland (AAGBI). It updates and replaces previous guidance published in 2003. Anaesthesia, 2009, 64, pages 199-21
Summary
(1) The AAGBI has published guidance on management of anaphylaxis during anaesthesia in 1990, 1995 and 2003. This 2008 update was necessary to disseminate new information.
(2) Death or permanent disability from anaphylaxis in anaesthesia may be avoidable if the reaction is recognised early and managed optimally.
(3) Recognition of anaphylaxis during anaesthesia is usually delayed because key features such as hypotension and bronchospasm more commonly have a different cause.
(4) Initial management of anaphylaxis should follow the ABC approach. Adrenaline (epinephrine) is the most effective drug in anaphylaxis and should be given as early as possible.
(5) If anaphylaxis is suspected during anaesthesia, it is the anaesthetist's responsibility to ensure the patient is referred for investigation.
(6) Serum mast cell tryptase levels may help the retrospective diagnosis of anaphylaxis: appropriate blood samples should be sent for analysis.
(7) Specialist (allergist) knowledge is needed to interpret investigations for anaesthetic anaphylaxis, including sensitivity and specificity of each test used. Specialist (anaesthetist) knowledge is needed to recognise possible non-allergic causes for the 'reaction'. Optimal investigation of suspected reactions is therefore more likely with the collaboration of both specialties.
(8) Details of specialist centres for the investigation of suspected anaphylaxis during anaesthesia may be found on the AAGBI websitehttp://www.aagbi.org.
(9) Cases of anaphylaxis occurring during anaesthesia should be reported to the Medicines Control Agency and the AAGBI National Anaesthetic Anaphylaxis Database. Reports are more valuable if the diagnosis is recorded following specialist investigation of the reaction.
(10) This guidance recommends that all Departments of Anaesthesia should identify a Consultant Anaesthetist who is Clinical Lead for anaesthetic anaphylaxis. Suspected anaphylactic reaction associated with anaesthesia guidelines.Enlace para bajar el artículo en PDF
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Alergia al latex |
Latex Allergy
Gare t h S . K a n t o r M.D., FRCP
C l e v e l a n d , U n i t e d S t a t e s o f America
Avances y Controversias en Anestesiología y Medicina del dolor "Opiniones Globalizadas" Editor: Dr. Victor Whizar-Lugo. E-book Gratuito Introduction
More than a dozen years have elapsed since the recognition of allergy to natural rubber latex (NRL) as a serious perioperative and occupational health problem.1,2 Despite this recognition, latex allergy remains the second most common cause of intraoperative anaphylaxis3 and one in fi fty healthcare workers4 becomes sensitized to latex each year through exposure to latex gloves. The epidemic1 of latex allergy5 has attracted attention, generating case reports,6 clinical mmunology research, epidemiologic studies,7 guidelines and task force reports,8,9,10 and reviews 11,12,13,14 which have provided insight into the prevalence, causes, and management of this worldwide problem. Guided by these findings anesthesiologists should be well equipped to diagnose and treat a latex allergic reaction, to create a perioperative environment that prevents the sensitization of healthcare workers to latex, and to protect those patients already affected by the allergy. This chapter is based on references gathered from recent review articles and task force papers, updated with a MEDLINE search from July 2002 to February 2004, using the key words anesthesia, anesthesiology, operating room (OR) or surgery, and latex, latex allergy, or latex hypersensitivity. A question and answer format is used to summarize aspects of current knowledge about latex allergy clinically relevant to the practicing anesthesiologist, with focus on newer evidence about rubber-stoppered medication vials, the true incidence of allergy among healthcare professionals, allergic and irritant contact dermatitis, glove selection, new therapeutic options, and the origins of the epidemic.
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| Alergia a Ropivacaína Peridural |
Dr. Victor M. Whizar-Lugo, Dra. Patricia Ontiveros-Morales, Dra. María E. Garfias-Flores.
Anestesia en México, 2004;16:180-183 Las reacciones alérgicas a los anestésicos locales del grupo amino amida son muy raras, y no hay casos reportados de alergias secundarios a la ropivacaína peridural. Informamos un paciente mexicano, de 62 años de edad, diabético con dolor torácico intenso secundario a herpes Zoster agudo, al cual se le realizó un bloqueo peridural con 6 mL de ropivacaína simple al 0.25% y 20 minutos después desarrolló una dermatosis pruriginosa localizada en el cuello y el tórax. Esta reacción se repitió con la segunda inyección peridural de 6 mL de ropivacaína simple al 0.125%, por lo que las subsecuentes inyecciones peridurales se hicieron con bupivacaína racémica 0.125%, sin efectos secundarios. El paciente fue seguido durante un año y no tuvo secuelas neurológicas, ni desarrolló neuropatía postherpética. Se ha dicho que los nuevos anestésicos locales levoisoméricos no inducen reacciones alérgicas. Este paciente demuestra que debemos de estar alertas ante esta remota posibilidad. Palabras clave: Alergias, anestésicos locales, ropivacaína epidural.
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