Anafilaxia perioperatoria/Perioperative anaphylaxis

Enero 2, 2016. No. 2194

Las reacciones no terapéuticas a los medicamentos pueden carecer de importancia o ser una amenaza para la vida-como las observados en el síndrome de Stevens-Johnson(http://anestesia-dolor.org/proyecto/sindrome-de-stevens-johnson-por-sulfas/ ) Las reacciones perioperatorias a drogas oscilan entre 1 en 20.000 a 1 en 1361. La mayoría de estas reacciones son generalmente clasificadas como IgE o no mediada por IgE. Las sospechas de reacciones adversas pueden subdividirse en función del mecanismo, por ejemploinmunológica (que requiere sensibilización por exposición previa) versus no inmunológica;tiempo (por ejemplo, inmediata o retardada), o si el fenómeno es dependiente de la dosis o no. Se pueden manifestar como una erupción simple, afectar a un solo o múltiples sistemas. El broncoespasmo e hipotensión son siempre sugerentes de tipo 1 o hipersensibilidadgeneralmente mediada por IgE. Es obligatorio registrar las reacciones adversas a drogas y el paciente debe de ser bien informado. Hoy comenzamos un serie de correos electrónicos con artículos sobre este tema.   Drugs non therapeutics consequences can be without importance or life-threatening like those observed in Stevens-Johnson syndrome (http://anestesia-dolor.org/proyecto/sindrome-de-stevens-johnson-por-sulfas/ ) The perioperative drugs reactions ranges from 1 in 20,000 to 1 in 1361. Most of these reactions are usually classified as IgE or non-IgE mediated. Suspected adverse drug reactions may be subdivided on the basis of mechanism e.g. immunological (requiring sensitization by previous exposure) versus nonimmunological; timing (e.g. immediate or delayed), or whether the phenomenon is dose dependent or not. They can manifest as a simple rash, affect a single or multiple systems. Bronchospasm and hypotension are always suggestive of type 1 or typically IgE- mediated hypersensitivity. It is mandatory to record drugs adverse reactions and the patient fully informed. Today we begin to e-mail you several articles on this subject. Anafilaxia perioperatoria Perioperative anaphylaxis. Berrío Valencia MI. Braz J Anesthesiol.2015 Jul-Aug;65(4):292-7. doi: 10.1016/j.bjane.2014.09.002. Epub 2015 Apr 28. Abstract BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes ofperioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed. CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids. CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis. KEYWORDS: Anafilaxia; Anaphylaxis; Anestesia; Anesthesia; Hipersensibilidade;Hypersensitivity; Perioperative period; Período perioperatório; Terapêutica; Treatment PDF La hipersensibilidad de tipo inmediato inducida por antibióticos es un factor de riesgo para pruebas cutáneas positivas de alergia para los bloqueadoresneuromusculares Antibiotic-induced immediate type hypersensitivity is a risk factor for positive allergy skin tests for neuromuscular blocking agents. Hagau N, Gherman N, Cocis M, Petrisor C. Allergol Int. 2015 Aug 29. pii: S1323-8930(15)00156-2. doi: 10.1016/j.alit.2015.07.007. [Epub ahead of print] Abstract BACKGROUND: Skin tests for neuromuscular blocking agents (NMBAs) are not currently recommended for the general population undergoing general anaesthesia. In a previous study we have reported a high incidence of positive allergy tests for NMBAs in patients with a positive history of non-anaesthetic drug allergy, a larger prospective study being needed to confirm those preliminary results. The objective of this study was to compare the skin tests results for patients with a positive history of antibiotic-induced immediate type hypersensitivity reactions to those of controls without drug allergies. METHODS: Ninety eight patients with previous antibiotic hypersensitivity and 72 controls were prospectively included. Skin tests were performed for atracurium, pancuronium, rocuronium, and suxamethonium. RESULTS: We found 65 positive skin tests from the 392 tests performed in patients with a positive history of antibiotic hypersensitivity (1 6.58%) and 23 positive skin tests from the 288 performed in controls (7.98%), the two incidences showing significant statistical difference (p = 0.0011). The relative risk for having a positive skin test for NMBAs for patients versus controls was 1.77 (1.15-2.76). For atracurium, skin tests were more often positive in patients with a positive history of antibiotic hypersensitivity versus controls (p = 0.02). For pancuronium, rocuronium and suxamethonium the statistical difference was not attained (p-values 0.08 for pancuronium, 0.23 for rocuronium, and 0.26 for suxamethonium). CONCLUSIONS: Patients with a positive history of antibiotic hypersensitivity seem to have a higher incidence of positive skin tests for NMBAs. They might represent a group at higher risk for developing intraoperative anaphylaxis compared to the general population. KEYWORDS: Antibiotic; Drug hypersensitivity; Latent sensitization; Neuromuscular blocking agent; Skin tests PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Síndrome Steven-Johnso

Diciembre 31, 2015. No. 2192

Análisis retrospectivo del síndrome de Stevens-Johnson y necrolisis tóxica epidérmica en 87 pacientes japoneses. Manejo y evolución Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 87 Japanese patients - Treatment and outcome. Yamane Y, Matsukura S, Watanabe Y, Yamaguchi Y, Nakamura K, Kambara T, Ikezawa Z, Aihara M. Allergol Int. 2015 Oct 9. pii: S1323-8930(15)00178-1. doi: 10.1016/j.alit.2015.09.001. [Epub ahead of print] CONCLUSIONS:Treatment with steroid pulse therapy in combination with plasmapheresis and/or immunoglobulin therapy seems to have contributed to prognostic improvement in SJS/TEN. PDF Necrolisis tóxica epidérmica y síndrome de Stevens-Johnson Toxic epidermal necrolysis and Stevens-Johnson syndrome. Harr T, French LE. Orphanet J Rare Dis. 2010 Dec 16;5:39. doi: 10.1186/1750-1172-5-39.Abstract Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. Both are rare, with TEN and SJS affecting approximately 1or 2/1,000,000 annually, and are considered medical emergencies as they are potentially fatal. PDF Características clínicas y resultados del tratamiento del síndrome de Stevens-Johnson y necrolisis tóxica epidérmica Clinical characteristics and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis. Chantaphakul H, Sanon T, Klaewsongkram J. Exp Ther Med. 2015 Aug;10(2):519-524. Epub 2015 Jun 5. PDF Secuelas tardías del síndrome de Stevens-Johnson y necrolisis tóxica epidérmica Long-term Sequelae of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Yang CW1, Cho YT, Chen KL, Chen YC, Song HL, Chu CY. Acta Derm Venereol. 2015 Nov 19. doi: 10.2340/00015555-2295. [Epub ahead of print]Abstract PDF Farmacovigilancia quimioinformática asistida: aplicación al síndrome de Stevens-Johnson. Cheminformatics-aided pharmacovigilance: application to Stevens-Johnson Syndrome. Low YS, Caster O, Bergvall T, Fourches D, Zang X, Norén GN, Rusyn I, Edwards R, Tropsha A. J Am Med Inform Assoc. 2015 Oct 24. pii: ocv127. doi: 10.1093/jamia/ocv127. [Epub ahead of print] PDF Síndrome de Stevens-Johnson y necrolisis tóxica epidérmica: Evolución materna y fetal en 22 embarazadas con HIV Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Maternal and Foetal Outcomes in Twenty-Two Consecutive Pregnant HIV Infected Women. Knight L, Todd G, Muloiwa R, Matjila M, Lehloenya RJ. PLoS One. 2015 Aug 12;10(8):e0135501. doi: 10.1371/journal.pone.0135501. eCollection 2015. PDF Nuevos hallazgos genéticos conducen el camino a una mejor comprensión de los mecanismos fundamentales de la hipersensibilidad de drogas. New genetic findings lead the way to a better understanding of fundamental mechanisms of drug hypersensitivity. Pirmohamed M, Ostrov DA, Park BK. J Allergy Clin Immunol. 2015 Aug;136(2):236-44. doi: 10.1016/j.jaci.2015.06.022. PDF Necrólisis epidérmica tóxica y síndrome de Stevens-Johnson: clasificación y actualidad terapéutica IGNACIO GARCÍA DOVAL,  JEAN-CLAUDE ROUJEAU,  MANUEL J. CRUCES PRADO Actas Dermosifiliogr 2000;91:541-551 PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015