Download Anaphylactic Reactions in Anesthesia and Intensive Care by Jerrold H. Levy PDF

By Jerrold H. Levy

ISBN-10: 075069064X

ISBN-13: 9780750690645

This booklet presents anaesthetists with a realistic method of the popularity, realizing, and administration of life-threatening reactions to anaesthesia and different medicinal drugs used in the course of surgical procedure and within the ICU

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Extra info for Anaphylactic Reactions in Anesthesia and Intensive Care

Sample text

36 I MECHANISMS OF ANAPHYLAXIS T h e most extensive h e m o d y n a m i c data was reported by Vigorito and c o workers, w h o administered histamine in four patients undergoing diagnostic cardiac catheterization with normal left ventricular function. Histamine was infused intravenously for 3 . 5 to 7 minutes at the rate o f 0 . 4 jxg/kg/min, producing histamine levels o f 4 . 6 ± 2 ng/mL (mean ± standard deviation). T h e y noted a significant decrease in systolic, diastolic, and mean aortic pressure, systemic vascular resistance, left ventricular end-diastolic pressure, and stroke index and a significant increase in heart rate, cardiac output, and left ventricular dP/dT m a x (Table 3 .

In the vasculature, prostaglandin D 2 produces slight enhancement o f microvascular permeability and systemic vasodilation. Intradermal injection pro- 46 I MECHANISMS OF ANAPHYLAXIS duces cutaneous vasodilation and a wheal and flare response (Lewis and Austen, 1 9 8 4 ; Stenson and Parker, 1 9 8 3 ) . Prostaglandin E2 M a s t cells and neutrophils are the m a j o r synthetic source o f prostaglandin E 2 (Stenson and Parker, 1 9 8 3 ) , which inhibits mitogenesis, lymphokine production, cytotoxicity, and antibody production and stimulates differentiation o f lymphocytes while stimulating nondirected migration (chemokinesis) o f polymorphonuclear leukocytes (Stenson and Parker, 1 9 8 3 ) .

H a receptor-induced vasoconstriction o f large capacitance c o r o n a r y arteries may prevail over peripheral vasodilation in patients with vasospastic angina, however. , 1 9 8 6 ) . T h e response is most likely due to stimulating vasoconstricting Hi receptors o f large epicardial c o r o n a r y arteries; however, in some patients there m a y also be a change o f geometry or stenosis secondary to hypotension, peripheral c o r o n a r y vasodilation, or the loss o f endothelium-derived relaxing factors due to atherosclerotic disease.

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