Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1993
Multicenter Study[Information to relatives of organ donors. Factors of consent or refusal. Results of a multicenter study].
The French law on organ harvesting in brain dead patients allows this to be done without the family's consent, but prescribes to inform the relatives. Despite this, most teams do not harvest organs if the family is strongly opposed to the procedure. Information given to the relatives is therefore a very important point in the management of the donor. ⋯ This ratio, which did not depend on the hospital, increased with the age of the donor: 66% for donors aged less than 18 years to 86% for those more than 50 years old. The aetiology of brain death was not a factor determining acceptance of the donation. The main factor was the conditions of interview: acceptance rate was the highest when there was a one hour delay between giving the information on the donor's brain death and that concerning organ donation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1993
The incidence and clinical features of anaphylactic reactions during anesthesia in Australia.
The details of 826 patients referred to an Anaesthetic Allergy Clinic over a 17-year period are described. 443 were classified as having severe immediate anaphylactic reactions and in the majority of these (263) a muscle relaxant was involved. In Australia, the most common cause of a reaction is alcuronium, which probably reflects usage, although it is the most commonly found to give a positive skin test in relaxant reactors. Suxamethonium and atracurium appear to have an incidence of reactions greater than predicted by market share and pancuronium and vecuronium appear safer both on incidence of reactions and on positive skin tests in reactors. ⋯ Cardiovascular collapse is the most common presenting problem and is the only problem in 10%. Skin changes are the next most common and then bronchospasm which may be transient and is the hardest feature to treat. With an investigation protocol based on history, skin and RIA testing subsequent anaesthesia is usually safe.
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Ann Fr Anesth Reanim · Jan 1993
Case Reports[Anaphylactic shock during the use of high doses of aprotinin in cardiac surgery].
A 77-year-old man was admitted for mitral valve replacement, 46 days after a failed conservative mitral surgery where he received high-dose aprotinin. Twenty minutes after induction of anaesthesia, 250 UPh E of aprotinin were infused intravenously; before the end of this infusion, bronchospasm, systemic hypotension and generalized rash were noted. ⋯ Aprotinin has the antigenic molecular structure of natural proteins. Since 1987, it is used in cardiac surgery to reduce postoperative blood loss: to prevent serious allergic reactions to aprotinin, it is necessary, in patients known to have had previous aprotinin therapy, to perform skin testing with diluted aprotinin before infusion.
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Ann Fr Anesth Reanim · Jan 1993
Diagnosis of IgE-dependent anaphylaxis to neuromuscular blocking drugs, thiopentone and opioids.
Although allergenic cross-reactivity of neuromuscular blocking drugs (NMBDs) is recognised clinically and has been firmly established at the serological and immunochemical levels, interpretation of in vitro inhibition findings for clinical purposes is not always straightforward. Points to be taken into account when considering serum IgE direct binding and inhibition results and when determining which NMBDs a patient may be sensitive to, include the relationship between in vitro potencies and clinical findings and the nature of the drug solid phase used for testing. It should also be remembered that the stimulating antigenic source for the patients' NMBD-reactive IgE antibodies is almost always unknown. ⋯ In screening sera of patients for IgE antibodies to thiopentone and morphine as well as NMBDs, multiple drug reactivities have been detected in a few subjects. Attention is drawn to defects in the existing thiopentone RIA although it is clear that the test is specific in patients who react to the drug. Addition of the serum tryptase assay to skin tests and IgE RIAs for NMBDs, thiopentone and morphine provides a powerful combination of diagnostic tests for the investigation of anaphylactoid reactions to anaesthetic drugs.
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Ann Fr Anesth Reanim · Jan 1993
Non specific interactions in anti-agent IgE-RIA to anesthetic agents.
The sensitivity of usual IgE-RIA for detecting seric anti-neuromuscular blocking drug (NMBD) IgE antibodies is low. Our group and other authors have proposed quaternary ammonium compounds other than NMBD for the preparation of sepharose solid drug phase. These compounds cannot be cyclohexenyl derivatives in order to prevent hydrophobic interactions with seric hydrophobic IgE. ⋯ Such hydrophobic IgE are seen in 30% of atopic subjects, in 41% of patients with drug allergy and in 100% of those allergic to propofol. The latter had also anti-quaternary ammonium IgE in 5 out of the 8 cases studied. These NMBD antibodies could bind to the quaternary-ammonium ion of the lecithins from Diprivan micelles.