Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Jan 1985
Case Reports[Anesthesia for emergency cesarean section after uterine rupture associated with recent fracture of the cervical spine].
General anaesthesia with intubation is preferable for emergency Caesarean section, whilst epidural anaesthesia should be reserved for elective Caesarean section. The case of a patient who required emergency Caesarean section following uterine rupture is discussed. ⋯ This avoided tracheal intubation and the possibility of worsening the cervical fracture. The end result was satisfactory, both for the mother and the child.
-
The histamine releasing potential of atracurium was assessed by testing skin reactivity in ten patients who had previously suffered from a preanaesthetic anaphylactoid accident, but in whom the diagnosis of anaphylaxis had not been confirmed. Atracurium was injected intradermally in increasing concentrations so as to determine the reactivity level, comparing it in the same patient with that due to d-tubocurarine and alcuronium given in the same way. Skin tests with histamine and 48/80 were also carried out at the same time. ⋯ All the commercial muscle relaxants together with atracurium were tested, even though none of the patients had ever received this last. Anaphylaxis was confirmed when the intradermal reaction was positive with a dilution of 1 in 1,000 and beyond. These tests showed that five patients out of the six had a crossed anaphylaxis, and one of these five was sensitive to all four muscle relaxants (atracurium included).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Ann Fr Anesth Reanim · Jan 1985
Randomized Controlled Trial Clinical TrialSkin testing in the investigation of reactions to intravenous anaesthetic drugs. A prospective trial of atracurium and tubocurarine.
Intradermal skin testing is widely used to determine the causative drugs of presumed anaphylactic anaesthetic reactions. This paper sets out to evaluate the usefulness of skin tests, both intradermal and prick testing, in the prediction of anaesthetic reactions. The muscle relaxant drugs tubocurarine and atracurium were chosen for study since they are known to produce a high incidence of minor histaminoid reactions. ⋯ The results of the trial, combined with external reports to this centre, indicate that intradermal testing of anaesthetic drugs, particularly muscle relaxants, produces a high incidence of false positive results. This probably reflects their pharmacological activity rather than antigenicity. It is recommended, therefore, that skin testing should be reserved for situations in which there are strong indications from laboratory tests, backed by case history, of immune sensitization.