羟氨苄青霉素引起大疱性类天疱疮样疹

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Guide to Clinical Preventive Services

Anaphylactic reactions to anaesthetic and associated agents used during the perioperative period have been reported with increasing frequency in most developed countries. Any drug administered in the perioperative period can potentially produce life-threatening immune-mediated anaphylaxis. Most published reports on the incidence of anaphylaxis come from France, Australia, the UK and New Zealand. These reflect an active policy of systematic clinical and/or laboratory investigation of suspected immune-mediated reactions. The estimated incidence of anaphylaxis ranges from 1:10,000 to 1:20,000. Muscle relaxants (69.1%) and latex (12.1%) were the most frequently involved drugs according to the most recent French epidemiological survey. Clinical symptoms do not afford an easy distinction between immune-mediated anaphylactic reactions and anaphylactoid reactions resulting from direct non-specific histamine release. Moreover, when restricted to a single clinical symptom, anaphylaxis can easily be misdiagnosed. Pre- and postoperative investigation must be performed to confirm the nature of the reaction, the responsibility of the suspected drugs and to provide precise recommendations for future anaesthetic procedures. These include plasma histamine, tryptase and specific IgE concentration determination at the time of the reaction and at skin tests 6 weeks later. In addition, since no specific treatment has been shown reliably to prevent the occurrence of anaphylaxis, allergy assessment must be performed in all high-risk patients. Treatment of anaphylaxis is aimed at interrupting contact with the responsible antigen, inhibiting mediator production and release, and modulating the effects of released mediators. It must be initiated as quickly as possible and relies on widely accepted principles. Finally, the need for proper epidemiological studies and the relative complexity of allergy investigation should be underscored. They represent an incentive for further development of allergo-anaesthesiology clinical networks to provide expert advice for anaesthetists and allergologists.

Allergic reactions occurring during anaesthesia

Prevalence of anaphylactic reactions to aprotinin: Analysis of two hundred forty-eight reexposures to aprotinin in heart operations

BACKGROUND: With introduction of the total mesorectal excision technique and preoperative radiotherapy in rectal cancer surgery, the local recurrence rate has decreased and the overall survival has ...

Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study.

Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia

General design: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). A randomised, placebo controlled, double-blinded, single-centre study is performed at an University Hospital (n = 40 patients for each group). This part presents the course of the individual patient and a complication algorithm for the management of anastomotic leakage and quality management.¶Objective: In part three of the protocol, the three major sections include:¶ - The course of the individual patient using a comprehensive graphic display, including the perioperative period, hospital stay and post discharge outcome.¶ - A center based clinical practice guideline for the management of the most important postoperative complication - anastomotic leakage - including evidence based support for each step of the algorithm.¶ - Data management, ethics and organisational structure.¶Conclusions: Future studies with immune modifiers will also fail if not better structured (reduction of variance) to achieve uniform patient management in a complex clinical scenario. This new type of a single-centre trial aims to reduce the gap between animal experiments and clinical trials or - if it fails - at least demonstrates new ways for explaining the failures.¶

Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). Protocol of a controlled clinical trial developed by consensus of an international study group. Part three: individual patient, complication algorithm and quality manage.

D. Duda, W. Lorenz, W. Dick, I. Celik, A. Black, M. J. R. Healy and J. W. Black Clinic of Anaesthesiology, Johannes Gutenberg University, Langenbeckstr. 1, D-55131 Mainz, Germany, Fax +49 6131 175518, e-mail: duda@goofy.zdv.uni-mainz.de Institute of Theoretical Surgery, Philipps University, Baldingerstr., D-35033 Marburg, Germany Department of Anaesthesia, Bristol Royal Infirmary, Bristol BS2 8HW, UK Departments of Medical Statistics and Epidemiology, London School of Hygiene and Tropical Medicine, 23 Coleridge Court, Milton Road, Harpenden, Herts AL5 5LD, UK James Black Foundation, 68 Half Moon Lane, Dulwich, London SE24 9JE, UK

Can clinically relevant histamine release be accurately diagnosed in anaesthetised patients without plasma histamine measurements? Randomised study with nested sampling aimed to change paradigms

A. Black

Papers

Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia

Can clinically relevant histamine release be accurately diagnosed in anaesthetised patients without plasma histamine measurements? Randomised study with nested sampling aimed to change paradigms