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Biomedical subjects

A Facon

Publications and source records attributed to A Facon.

9 recordsLinked to original sources
PubMed1995

Anaphylactic reaction to local administration of rifamycin SV.

BACKGROUND AND OBJECTIVE: Systemic reactions during anesthesia are commonly attributed to muscle relaxants, hypnotics, macromolecular solutions, latex, or parenteral antibiotics. After exclusion of these different components as causes, we were interested in the potential implication of rifamycin in the systemic reaction, which occurred during anesthesia, and in the immunologic mechanism by which it can trigger this reaction. METHODS: We report four cases of systemic reactions occurring after local administration of rifamycin. Three patients needed orthopedic surgery, and the fourth needed a urethrotomy. Severe systemic reactions occurred in all four patients when the surgeon washed the incision area with a rifamycin solution. All patients correctly responded to appropriate treatment and recovered. Skin tests were performed 2 months after the incident with the drugs used during anesthesia, latex, and rifamycin. To assess the relationship with a possible IgE-mediated mechanism, two in vitro tests were concomitantly performed to evaluate the cell reactivity to rifamycin: (1) determination of histamine release from peripheral basophils and (2) platelet cytotoxicity test, which explored the presence on platelets of specific IgE antibodies bound to the low-affinity receptor for IgE. RESULTS: Skin tests were performed with different drugs used during surgery, and results were only positive for rifamycin in the four cases, accompanied in two cases by a systemic reaction. Histamine release from basophils was positive in three of four patients. The platelet cytotoxicity test results were positive in all four cases. CONCLUSION: It appears that rifamycin, used locally during surgery, is apt to trigger severe systemic anaphylactic reactions, which are linked to an IgE-related process. This situation is worth pointing out, especially in patients who undergo repeated orthopedic operations during which, at least in Europe, rifamycin is commonly used for the prevention of local sepsis.

Administration, Topical↗
PubMed1990

[Anesthetics responsible for anaphylactic shock. A French multicenter study].

Combined allergological and anaesthetic consultations have been started in the last few years in eight French Teaching Hospitals so as to explore peranaesthetic anaphylactoid shocks. A survey was carried out in these centers in order to collect patients investigated with the same protocol, for the assessment of the incidence of anaphylaxis in France, as well as the involved drugs. Investigations were always carried out at least 6 to 8 weeks after the accident. The tests used to diagnose IgE-dependent anaphylaxis were skin tests (prick and intradermal tests, carried out in all eight centers), the radioimmunological assay of specific anti-quaternary ammonium IgE, together with an inhibition test with thiopentone and propofol (six centers), leukocyte histamine release (five centers) and human basophil degranulation tests (three centers) for those drugs for which no specific antibody assay exists. The collected data involved 1,240 patients, investigated within the last four years. Anaphylaxis was diagnosed in 821 patients (66.2%). Muscle relaxants were responsible in 668 cases (80% of cases of anaphylaxis). Suxamethonium was the main cause (54.3% of shocks due to muscle relaxants), followed by vecuronium (15.3%). General anaesthetics (hypnotics and benzodiazepines) were responsible for 9.2% of all cases of anaphylaxis opioids for 2.6%. There were only three cases of shock due to local anaesthetic agents. Latex and ethylene oxide are becoming increasingly involved. It would therefore seem mandatory to carry out after any anaphylactoid accident an assessment with sensitive and specific tests for anaphylaxis. Diagnosing anaphylaxis means that the involved drug should be used never again in that patient. Because muscle relaxants are by far the most involved drugs, anaesthetists should use them only when really required.

Analgesics, Opioid↗
PubMed1985

[Value of leukocytic histamine liberation tests and intradermal tests in the diagnosis of anaphylactoid reactions to anesthetic products].

Skin tests and leukocyte histamine release (LHR) were carried out in 14 patients who had presented an anaphylactic reaction during general anaesthesia; they were compared with a control group of 14 normal subjects. Histamine release was measured by a fluorimetric method after contact in vitro between patient's basophils and native drug at various concentrations. More than 10% LHR and a diphasic release curve were considered to be mandatory to certify an anaphylactic origin. The reliability and the specificity of the LHR seemed excellent. The discriminative power between the two groups was statistically significant (p less than 0.0001). Except for two cases, investigated soon after the accident, in which the total histamine level was too low, LHR appeared reliable and its association with skin tests gave the diagnosis of anaphylaxis in 13 of the 14 cases.

Adult↗
PubMedDate not supplied

[Evaluation of the histamine-liberating property of midazolam].

The variations of plasma histamine levels were studied in two groups of ten patients arriving in the operating room; the first group received midazolam, and the second a saline isotonic solution. The plasma histamine levels were compared, for each patient, to the histamine level measured the day before the operation. An histamine release was found as soon as the patient arrived in the operating room. No variation of the histamine level was found after the injection of midazolam.

Female↗
PubMedDate not supplied

[Allergy to anesthetic agents: analysis of 96 recent cases].

This retrospective study concerning 96 observations from 1984 to 1987 allows to estimate the incidence of anaphylactoid reactions, the risk factors and the drugs involved in these accidents. During these three years, 96 anaphylactoid reactions due to anaesthetic drugs were collected. These anaphylactoid reactions were investigated by intradermal skin tests and in vitro by leukocyte histamine release. The drugs most often involved were the muscle relaxants and over all suxamethonium. This muscle relaxant must be reserved to strict indications.

Adolescent↗