Annales Francaises D Anesthesie Et De Reanimation 

About: Annales Francaises D Anesthesie Et De Reanimation is an academic journal. The journal publishes majorly in the area(s): Intensive care & Poison control. It has an ISSN identifier of 0750-7658. Over the lifetime, 7011 publications have been published receiving 37398 citations.

Épidémiologie des réactions anaphylactoïdes peranesthésiques. Quatrième enquête multicentrique (juillet 1994-décembre 1996)

Abstract: Since 1984 an epidemiological survey of anaphylactoid reactions occurring during anaesthesia has been obtained in France with regular repeated inquiries by the Perioperative Anaphylactoid Reactions Study Group (Gerap). The members of this group collected during the study period cases of patients having suffered from an anaphylactoid reaction and subsequently tested in their allergoanaesthetic outpatient clinic. The three previous surveys published in the Annales francaises d'anesthesie et de reanimation in 1990, 1993 (in English) and 1996 included 1,240, 1,585 and 1,730 patients respectively. The current survey concerned 1,648 patients, tested by the GERAP (38 diagnostic centres) from July 1994 to December 1996. The diagnostic tests for IgE anaphylaxis were cutaneous tests (prick tests and intradermal tests), which minimal dilutions for specific positive skin test were previously determined by comparison with control subjects. The cutaneous tests were performed by all the centres. These tests were associated, in 29 centres, with the detection of specific IgEs against quaternary ammonium compound and inhibition test, and detection of IgEs against propofol, thiopental and latex. Moreover, leukocyte histamine release test was performed in seven centres. The mechanism of the reaction was: anaphylaxis in 692 patients (characteristic clinical symptoms and positive allergological tests), anaphylactoid reactions in 611 patients (characteristic clinical symptoms and negative allergological tests), and other causes in 345 patients (unusual clinical symptoms and negative allergological tests). An immune mechanism was found in 53% of the reactions, with characteristic clinical symptoms occurring during anaesthesia. The 692 cases of anaphylaxis were due to 734 substances (double anaphylaxis in 42 patients): muscle relaxants (61.6%), latex (16.6%), antibiotics (8.3%), hypnotics (5.1%), colloids (3.1%), opioids (2.7%) and others (2.6%) among which aprotinin (four cases) ethylene oxide (five cases) local anaesthetics (two cases). The muscle relaxants implicated in anaphylactic reactions included: vecuronium (n = 130), atracurium (n = 107), suxamethonium (n = 106), pancuronium (n = 41), rocuronium (n = 41), mivacurium (n = 18), and gallamine (n = 9). These results reflected French anaesthetic practice, except for suxamethonium (5% of the French market share of curares). In 70% of the patients who were allergic to one muscle relaxant, cross-sensitivity was found with the other relaxants. The comparison with the three previous surveys confirms that the mechanism of about half of the anaphylatoid reactions occurring during anaesthesia is of immune origin, due to specific IgE antibodies. Muscle relaxants remain the most common cause of anaphylaxis, followed by latex whose incidence seems to decrease, whereas the incidence of anaphylaxis to antibiotics increases. Incidence of reactions to suxamethonium decreased, corresponding however to one quarter of all muscle relaxant anaphylaxis, similar with vecuronium and atracurium. For this survey, more clinical information was obtained in 583 patients, allowing the following conclusions: reactions were always more severe in case of anaphylaxis than nonspecific histamine release; reactions occurred more frequently in females (F/M = 2.5); 17% of patients allergic to a muscle relaxant were never anaesthetized beforehand; a history of reactions during previous anaesthetics was a risk factor for a reaction during subsequent anaesthetics; neither drug allergy nor atopy (except for latex allergy) were a predisposing factor for reactions with anaesthetic agents. Considering that in 1996, 8 million anaesthetics were administered in France, of which 2.5 million included the use of muscle relaxants, the overall incidence for anaphylactic reactions, all agents included, was evaluated as 1 in 13,000 anaesthetics, while the incidence of anaphylaxis to muscle relaxants was 1 in 6,500 anaesthetics.

The incidence and clinical features of anaphylactic reactions during anaesthesia in Australia

Abstract: 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. The incidence of reactions is between 1:10,000 and 1:20,000 anaesthetics. Patients who react have greater incidence of allergy, atopy, asthma and previous reactions than non reactors. Previous exposure is usually apparent in reactors to induction agents but not muscle relaxants. 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.

Réactions anaphylactoïdes aux substituts colloïdaux du plasma : incidence, facteurs de risque, mécanismes. Enquête prospective multicentrique française

Abstract: Resume L'evolution dans les pratiques transfusionnelles conduit a utiliser abondamment les substitus colloidaux du plasma dont la gamme s'est recemment enrichie par la commercialisation des amidons. Le choix des substituts repose en partie sur la connaissance de leurs effets secondaires, dont les reactions anaphylactoides. Le but de ce travail a ete d'apprecier l'incidence et la gravite des reactions en fonction des types de substituts disponibles en France, de rechercher d'eventuels facteurs de risque et de determiner le mecanisme des reactions. L'enquete a ete prospective, realisee dans 49 etablissements hospitaliers publics et prives dissemines sur tout le territoire francais, et a dure 15 mois (juin 1991 a octobre 1992). Une feuille de recueil des donnees etait remplie pour tout patient a qui un substitut etait administre, qu'il y ait ou non incident. En cas d'accident, un bilan immunoallergologique etait realise en 2 temps : immediat pour permettre le dosage de tryptase serique, anticorps antigelatines, methylhistamine urinaire, et 4 a 6 semaines apres pour realiser les tests allergologiques cutanes. Le collectif etudie a ete de 19 593 patients qui ont recu des gelatines (48,1 %), des amidons (26,7 %), des albumines (15,7 %) et des dextrans (9,5 %). Il y a eu 43 reactions anaphylactoides representant une incidence globale de reactions de 0,219 % soit 1 reaction pour 456 patients traites. L'incidence a ete differente suivant les substituts : gelatines : 0,345 %, dextrans : 0,273 %, albumines : 0,099 %, amidons : 0,058 %. Dans 20 % des cas, ces reactions ont ete severes, de grade III ou IV. Par une analyse multivariee, 4 facteurs de risque ont ete isoles, independants l'un de l'autre : il s'agit de l'administration de gelatines (Odds Ratio = OR : 4,81), de dextrans (OR = 3,83) ; les antecedents d'allergie medicamenteuse (OR = 3,16), le sexe masculin (OR = 1,98). L'estimation du risque relatif de reaction anaphylactoide d'un substitut par rapport a l'autre a montre qu'avec les amidons le risque etait 6 fois moindre qu'avec les gelatines, 4,7 fois moindre qu'avec les dextrans. Le risque represente par les albumines etait 3,4 fois moindre qu'avec les gelatines et pratiquement identique a celui des amidons. Le bilan immunoallergologique n'a pu etre realise que chez 15 patients ayant recu des gelatines (Plasmion®). La preuve d'une anaphylaxie IgE-dependante a pu etre apportee chez 7 d'entre eux. En conclusion, il est apparu que, pour reduire au maximum le risque de reaction anaphylactoide, on devrait eviter d'utiliser les gelatines et les dextrans en cas d'allergie medicamenteuse anterieure. Il est necessaire de pratiquer un bilan allergologique en cas d'accident car celui-ci peut etre lie a la presence d'anticorps, cc qui contre-indiquerait l'administration ulterieure du substitut incrimine.

Épidémiologie des réactions anaphylactiques et anaphylactoïdes peranesthésiques en France. Septième enquête multicentrique (Janvier 2001–Décembre 2002)

Abstract: Resume Objectifs. – Les reactions d’hypersensibilite immediate, qu’elles soient mediees par les immunoglobulines E (anaphylaxies) ou non-immunomediees (reactions anaphylactoides) survenant au cours de l’anesthesie demeurent un sujet de preoccupation majeure pour les anesthesistes, dans la mesure ou elles surviennent souvent de maniere imprevisible, peuvent menacer la vie, et reagissent parfois mal au traitement habituel. Les auteurs rapportent les donnees de la derniere enquete nationale effectuee par le GERAP (Groupe d’Etudes des Reactions Anaphylactoides Peranesthesiques) en 2001 et 2002, et comparent les resultats avec ceux des enquetes precedentes. Patients et methodes. – Au total 712 patients ayant presente une reaction d’hypersensibilite immediate ont ete adresses en consultation dans l’un des 40 centres d’allergo-anesthesie du GERAP. Le diagnostic d’anaphylaxie reposait sur l’existence d’une histoire clinique caracteristique, d’une elevation des taux de tryptase serique prelevee au moment de la reaction, et de tests cutanes et/ou d’IgE specifiques positifs, dans le cas contraire les reactions etaient qualifiees de reactions anaphylactoides. Resultats. – Une anaphylaxie a ete diagnostiquee chez 491 patients (69 %), une reaction anaphylactoide chez 221 patients (31 %). Les medicaments les plus frequemment responsables d’une anaphylaxie etaient les curares ( n =271, 55 %), le latex ( n =112, 22,3 %) et les antibiotiques ( n =74, 14,7 %). La succinylcholine ( n =102, 37,6 %) et le rocuronium ( n =71, 26,2 %) ont ete les curares les plus frequemment incrimines. Une reaction croisee entre differents curares a ete retrouvee dans 63,4 % des cas. Aucune difference n’a ete observee dans les antecedents des patients ayant presente une reaction anaphylactique ou anaphylactoides (ex. atopie, intolerance alimentaire ou medicamenteuse). Cependant, l’incidence de l’atopie ou d’une intolerance alimentaire etait plus elevee en cas d’anaphylaxie au latex comparee aux curares. Les manifestations cliniques etaient plus severes en cas d’anaphylaxie. Dans cette enquete, la valeur predictive positive d’une elevation du taux de tryptase serique pour le diagnostic d’anaphylaxie a ete estimee a 95,3 %, la valeur predictive negative a 49 %. L’interet du dosage des IgE specifiques des curares a ete confirme. Conclusion. – Ces resultats confirment la necessite d’un bilan systematique en cas de survenue d’une reaction d’hypersensibilite immediate survenant au cours de l’anesthesie, et l’interet du developpement de centres de consultation specialise en allergo-anesthesie capables d’apporter une aide aux anesthesistes et aux allergologues.

Guidelines for perioperative haemodynamic optimization.

Abstract: B. Vallet *, Y. Blanloeil , B. Cholley , G. Orliaguet , S. Pierre , B. Tavernier a a Pole d’anesthesie reanimation, hopital Huriez, CHRU de Lille, rue Polonovski, 59037 Lille cedex, France b Service d’anesthesie-reanimation chirurgicale, hopital G.-et-R.-Laennec, CHU de Nantes, 44093 Nantes cedex 1, France c Service d’anesthesie-reanimation, hopital europeen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France d Service d’anesthesie-reanimation, hopital universitaire Necker–Enfants-Malades, universite Paris Descartes, Assistance publique–Hopitaux de Paris, 149, rue de Sevres, 75743 Paris cedex 15, France e Institut Claudius-Regaud, 20–24, rue du Pont-Saint-Pierre, 31052 Toulouse Cedex, France