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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathophysiologic effects of histamine in anaphylaxis have been shown to be mediated through H1 and H2 receptors, individually and in combination. H1 receptors mediate coronary artery vasoconstriction, wheezing, cutaneous vascular permeability, and possibly an increase in pulse rate. H2 receptors stimulate ventricular and atrial inotropy, arterial chronotropy, coronary vasodilation, and rises in basophil cyclic adenosine 3':5' monophosphate (cyclic AMP). (Neither receptor mediates increases in cyclic AMP in mast cells.) H1 and H2 receptors in combination seem to be most potent in mediating flush, headache, increases in pulse pressure, and decreases in diastolic blood pressure. Clinical trials have been conducted to determine the efficacy of H1 and H2 antagonists in preventing anaphylactic reactions to plasma expanders, anesthesia-inducing agents, morphine, and radiocontrast material. Concurrently, retrospective observations of the prevention of anaphylactic reactions to chymopapain have been recorded. Despite some conflicting and inconclusive data, the sum of these studies indicates that pretreatment with a combination of H1 and H2 antagonists is more effective than H1 antagonists alone in preventing reactions to these agents. These results, when added to the available knowledge of the physiology of histamine release, support the preferential use of H1/H2 antagonist combinations in the prevention and treatment of anaphylaxis and anaphylactoid reactions.
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PMID:The use of antihistamines in the prevention and treatment of anaphylaxis and anaphylactoid reactions. 197 85

We carried out a randomized comparison study with 69 patients, one group of whom had been operated on (41) and the other group treated by chemonucleolysis with chymopapain (25) in order to arrive at an objective picture of the latter recently much criticised method. 88% of the patients who were treated with chymopapain showed lasting success, and almost 90% of the operated patients are also in a good condition. In our opinion, complications can be avoided and the patient can be spared a surgical operation by the correct choice of patients and proper performance of the method in standby anaesthesia. This justifies the performance of chemonucleolysis with chymopapain.
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PMID:[Chemonucleolysis with chymopapain in lumbar disk hernia. Randomized comparative study with operated patients]. 226 6

Histamine release can occur in response to anaphylactic or chemically mediated anaphylactoid reactions during general anesthesia. Narcotics and muscle relaxants have been demonstrated both in vitro and in vivo to cause significant histamine release. This histamine release appears to be directly related to changes in the cardiovascular system that are often seen during anesthesia. The use of combined H1 and H2 antagonists to attenuate the effects of anaphylactoid reactions in humans has been shown in several controlled trials. In addition, recent experience with chymopapain administration suggests that the use of H1 and H2 antagonists may be useful in the prophylaxis of immunologically mediated reactions.
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PMID:Histamine release in anesthesia and surgery. 244 87

Chymopapain is a proteolytic enzyme used in the chemonucleolysis of the herniated nucleus pulposus of lumbar intervertebral discs. It causes rapid hydrolysis of the noncollagenous polypeptides that maintain the tertiary structure of the chondromucoprotein of the nucleus pulposus. We report here an anaphylactoid reaction after the intervertebral injection of chymopapain.
Anaesthesia 1989 Sep
PMID:Anaphylactoid reaction to chymopapain. 239 12

Percutaneous diskectomy, particularly using Onik's nucleotome, has promise. It is too early, however, to decide if the percutaneous approach to reducing lumbar disk herniation will achieve a permanent place in the surgical armamentarium. Nevertheless, it is clear that patient selection is important. At the minimum, an adequate trial of conservative therapy must be followed by diagnostic imaging that documents a herniation that can be treated in this fashion and correlates with the patient's neurological signs and symptoms. If free fragments are found, a laminectomy of some sort will be required to remove the offending material. Patients who are at risk for general anesthesia or may be allergic to chymopapain were mentioned by the panel as special subpopulations for whom the procedure may be indicated despite the lack of wide experience with it. The rapidly rising popularity of automated percutaneous lumbar diskectomy via the nucleotome will hopefully be followed in the near future with larger studies with long-term follow-up.
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PMID:Diagnostic and therapeutic technology assessment. Percutaneous lumbar diskectomy for herniated disks. 277 12

An automated technique for percutaneous lumbar discectomy applies the principle of suction cutting. The indications are leg pain greater than back pain (sciatica) and failure of all conservative therapy. The typical neurological and roentgenographic abnormalities of a contained herniated lumbar disc are mandatory. The procedure is performed with a Nucleotome (Surgical Dynamics, San Leandro, California) that is a specially designed, 2-mm blunt-tipped suction-cutting device inserted via a posterolateral approach into the affected disc using fluoroscopic control. The results that can be expected with the technique are similar to chymopapain and are in the 70% success range. Automated percutaneous discectomy has a demonstrably low morbidity and can be performed under local anesthesia on an outpatient basis.
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PMID:Percutaneous automated discectomy. A new approach to lumbar surgery. 291 Jun 19

After treatment of herniation of a lumbar disc by injection of the enzyme chymopapain, i. e. after chemonucleolysis, anaphylactic reactions can occur in about one per cent of the cases. In order to recognise the pattern of signs associated with such reactions, well in advance, while avoiding the additional risk of general anaesthesia, some authors propagate local anaesthesia. We report on our perioperative procedure in 102 cases of chemonucleolysis under local anaesthesia. Prick's tests were carried out before surgery to exclude sensitization to the substances to be injected. In two cases only due to a positive prick test to chymopapain chemonucleolysis had to be effected with collagenase; as a matter of fact, collagenase is not known to have caused any anaphylactic reactions, but it may be responsible for local side effects, such as destruction of adjacent tissues. The patients were kept under observation by an anaesthetist during and after surgery. No anaphylactic reaction was seen. Chemonucleolysis appears to be a suitable treatment method provided it is carried out under local anaesthesia with the same precautions as applied under regional anaesthesia by the anaesthetist.
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PMID:[Anesthesiologic aspects of chemonucleolysis in local anesthesia]. 299 Feb 49

A prospective, multiinstitutional, double-blind trial comparing the effect of chymopapain (Discase) vs. placebo (cysteine-edetate-iothalamate: CEI) for lumbar intervertebral disc rupture with sciatica was carried out on 173 patients, the largest such study reported to date. Patients were matched with respect to age, sex, physical habitus, and level of injection. The procedure was carried out under local anaesthesia. The success rate was superior in the chymopapain group regardless of the method used to assess outcome or the time over the first 6 months at which the two groups were compared: 71% vs. 45% if code breaks were analyzed at 6 months, and 67% vs. 44% if code breaks were defined as lost to follow-up. A single case of anaphylaxis and one case of septic discitis were the only serious complications noted. This study supports the role of chymopapain in the treatment of lumbar disc rupture with sciatica.
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PMID:Safety and efficacy of chymopapain (Discase) in the treatment of sciatica due to a herniated nucleus pulposus. Results of a randomized, double-blind study. 318 1

Allergic reaction following chemonucleolysis with chymopapain is responsible for half of all known complications of this treatment. Although the incidence of allergic reactions is comparatively low one should not underestimate the danger involved. If chemonucleolysis is performed under local anaesthesia, the risk of an anaphylactic reaction is reduced. If no pre-operative test methods are available, the patient risk can be considerably lessened by suitable premedication and by keeping anti-allergics within easy reach during intradiscal therapy. Exclusion of patients who have a previous history of allergy from chemonucleolysis will not result in additional safety. The specificity of the serological tests is very high, but their sensitivity and reliability in respect of prediction of an allergic reaction with positive or negative test result is comparatively low. They take up a lot of time (24 hours) and require skilled personnel trained in laboratory chemistry. The chymopapain prick test is simple to perform and the result of the test rapidly available (15 minutes). The danger of allergic reactions to the prick test itself is negligibly small, as experience has shown. At the present time no comparative tests are available between serological tests and skin tests in a large group of patients, so that we can say something about the reliability only on the basis of empirical data. Of the 352 test-negative patients investigated so far, none had an allergic immediate reaction to chymopapain. Even if we take the possibility of false positive skin tests into consideration, we believe that it would not be appropriate with a positive skin test to perform chemonucleolysis.
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PMID:[Incidence and prevention of allergic reactions following chemonucleolysis with chymopapain]. 349 35

Chemonucleolysis and lumbar laminectomy after unsuccessful chemonucleolysis are now common and accepted surgical procedures that require precise perioperative management based on a thorough understanding of the pathophysiology of chymopapain-induced anaphylaxis and the herniating nucleus pulposus syndrome. Preoperative management with appropriate screening tests, antihistamines, and steroids, combined with thoughtful premedication and vigilant monitoring during local or general anesthesia, can provide safe anesthetic management of patients having chemonucleolysis with chymopapain.
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PMID:Anesthetic management of chemonucleolysis with chymopapain. 353 30


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