Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Increased concentrations of mast cell tryptase are a highly sensitive indicator of anaphylactic reactions during anaesthesia. We obtained serum specimens from 350 patients after possible anaphylactic reactions during anaesthesia. Serum was collected from patients in our own institution (27), and transported by mail and courier from other hospitals in response to a request in the medical literature (323). Concentrations of mast cell tryptase were measured in 416 specimens. Intradermal testing was performed in 217 patients and radioimmunoassay for drug-specific antibodies with serum in 198 patients. Mast cell tryptase concentrations were increased in 158 patients, equivocal in 10 and not increased in 182. There was a significant difference in the incidence of positive intradermal tests, radioimmunoassay tests and evidence of an IgE-mediated reaction in patients whose mast cell tryptase concentrations were increased. Seven of 143 patients whose mast cell tryptase concentrations were not increased at appropriate sampling times had positive tests for IgE antibodies, and in 33 of 158 patients with increased mast cell tryptase concentrations no IgE antibodies were detected. We conclude that increased mast cell tryptase concentrations are a valuable indicator of an anaphylactic reaction during anaesthesia. Their presence favours an IgE-mediated cause but does not always distinguish between anaphylactoid and anaphylactoid reactions, and patients in whom mast cell tryptase concentrations are not increased still require skin testing.
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PMID:Mast cell tryptase in anaesthetic anaphylactoid reactions. 1084 54

BACKGROUND: Mechanisms involved in the development of colon- ic ischaemia are not fully understood and there are conflicting reports regarding predisposing factors. The aim of this study was to evaluate the effect of dopexamine hydrochloride on the incidence of colonic ischaemia following aortic surgery and to correlate immunohistochemical markers of inflammatory activation in its pathogenesis. METHODS: Thirty patients, of mean age 65 (range 46-84) years, undergoing elective infrarenal aortic surgery were randomized to receive a perioperative infusion of either dopexamine 2 &mgr;g kg-1 min-1 (n = 12) or 0.9 per cent saline placebo (n = 18). All patients underwent colonoscopy and biopsy following induction of anaesthesia and at 1 week after operation. Sections were stained with haematoxylin and eosin, and for mast cell tryptase (MCT), myeloperoxidase (MPO) and both the inducible (iNOS) and endothelial (eNOS) isoforms of nitric oxide synthase. Sections were analysed blindly and independently by two histopathologists. Patient and operative data were collected and stored separately. RESULTS: Colonic ischaemia was noted in nine patients based on microscopic findings. Endoscopy alone had a sensitivity of 56 per cent. There was a significantly lower incidence of colonic ischaemia in patients receiving dopexamine compared with placebo (P < 0.05). One death resulted from colonic infarction in the placebo group 11 days after operation. There was increased MPO and MCT expression in patients with histological evidence of ischaemia (P < 0.05); iNOS staining within the vascular (P = 0.001) and lamina propria (P < 0.05) components of the mucosa was also significantly greater. No association was found with eNOS. CONCLUSION: Perioperative dopexamine infusion confers a degree of protection to colonic mucosa following aortic surgery, possibly through an anti-inflammatory effect.
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PMID:Vascular surgical society of great britain and ireland: randomized double-blind study of dopexamine versus placebo in aortic surgery 1036 28

Radioimmunoassays (RIAs) for IgE antibodies to specific neuromuscular blocking drugs (NMBDs) are an important tool in the diagnosis of anaphylaxis during anaesthesia although they are performed in only a few laboratories throughout the world. NMBDs bind to antibodies by their substituted ammonium ions. We measured serum IgE antibodies to morphine and specific NMBDs in 347 patients with suspected anaphylaxis using blood specimens sent for mast cell tryptase assays. Morphine, which has a single substituted ammonium group, avidly binds in vitro to antibodies that react with NMBDs. The morphine RIA proved to be both a more sensitive and efficient test for the detection of IgE antibodies to NMBDs than the specific NMBD RIAs. We have adopted the morphine RIA in our laboratory in preference to the specific RIAs and predict that use of this single assay will become widespread for the in vitro diagnosis of allergic sensitivities to NMBDs.
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PMID:Immunoassays in the diagnosis of anaphylaxis to neuromuscular blocking drugs: the value of morphine for the detection of IgE antibodies in allergic subjects. 1078 68

A patient developed anaphylaxis during anaesthesia, towards the end of surgery, 30 s after intravenous administration of neostigmine. Anaphylaxis to neostigmine was confirmed by demonstrating an elevated mast cell tryptase and a strongly/positive skin prick test, showing the presence of drug-specific IgE (skin prick tests to neostigmine were negative in normal subjects). This is a rare cause of anaphylaxis during anaesthesia.
Anaesthesia 2000 Jun
PMID:Anaphylaxis caused by neostigmine. 1101 27

Patients suspected of anaphylaxis during anaesthesia have been referred to the senior author's clinic since 1974 for investigation. Since release of rocuronium on to the worldwide market, concern has been expressed about its propensity to cause anaphylaxis. We identified 24 patients who met clinical and laboratory (intradermal, mast cell tryptase and morphine radioimmunoassay) criteria for anaphylaxis to rocuronium. The incidence of rocuronium allergy in New South Wales, Australia has risen in parallel with sales, while there has been an associated fall in reactions to other neuromuscular blocking drugs. Data from intradermal testing suggested that rocuronium is intermediate in its propensity to cause allergy in known relaxant reactors compared with low-risk agents (e.g. pancuronium, vecuronium) and higher-risk agents (e.g. alcuronium, succinylcholine).
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PMID:Rocuronium: high risk for anaphylaxis? 1187 44

Mast cells, which are granulocytes found in peripheral tissue, play a central role in inflammatory and immediate allergic reactions. beta-Tryptase is a neutral serine protease and is the most abundant mediator stored in mast cell granules. The release of beta-tryptase from the secretory granules is a characteristic feature of mast cell degranulation. While its biological function has not been fully clarified, mast cell beta-tryptase has an important role in inflammation and serves as a marker of mast cell activation. beta-Tryptase activates the protease activated receptor type 2. It is involved in airway homeostasis, vascular relaxation and contraction, gastrointestinal smooth muscle activity and intestinal transport, and coagulation. Serum mast cell beta-tryptase concentration is increased in anaphylaxis and in other allergic conditions. It is increased in systemic mastocytosis and other haematological conditions. Serum beta-tryptase measurements can be used to distinguish mast cell-dependent reactions from other systemic disturbances such as cardiogenic shock, which can present with similar clinical manifestations. Increased beta-tryptase levels are highly suggestive of an immunologically mediated reaction but may also occur following direct mast cell activation. Patients with increased mast cell beta-tryptase levels must be investigated for an allergic cause. However, patients without increased mast cell tryptase levels should be investigated if the clinical picture suggests severe anaphylaxis.
Anaesthesia 2004 Jul
PMID:Mast cell tryptase: a review of its physiology and clinical significance. 1520 May 44

Anaphylactic and anaphylactoid reactions during anaesthesia are rare, but potentially life-threatening allergic events. The worst manifestations are cardiovascular collapse, bronchospasm and laryngeal oedema. Anaphylactic and anaphylactoid reactions are clinically indistinguishable. The most incriminated agents are neuromuscular blocking drugs and latex. Treatment consists of instant interruption of contact with possible antigens, 100% oxygen, intubation, adrenaline and volume expansion. The incidence of cross-reactivity between neuromuscular blocking drugs is high. Further investigation of a suspected anaphylactic reaction is mandatory to find the responsible drug and to make future anaesthesia safe. Diagnosis is made with intraoperative tests (serum histamine and mast cell tryptase) and postoperative tests (skin tests and RASTs for specific IgE antibodies).
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PMID:Anaphylaxis during anaesthesia: diagnosis and treatment. 1551

A 42-year-old male underwent a total hip arthroplasty under subarachnoid anaesthesia with intrathecal bupivacaine and diamorphine. Shortly after the start of surgery, he suffered an allergic reaction that, at first, was difficult to distinguish from the recognised side-effects of intrathecal diamorphine. Once the diagnosis was made, he was treated with adrenaline and made a full recovery. The serum concentration of mast cell tryptase approximately 1.5h after the onset of the adverse incident confirmed an anaphylactic reaction. Skin prick testing several weeks later identified diamorphine as the likely causative agent, a drug overlooked initially as a potential cause. We believe this is the first report of intrathecal diamorphine causing anaphylaxis.
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PMID:Anaphylaxis to intrathecal diamorphine. 1690 9

Profound hypotension and cardiac arrest after commencement of combined spinal and general anaesthesia in a patient for knee replacement surgery raised the suspicion of anaphylaxis. This seemed to be confirmed when a mast cell tryptase test taken about 90 minutes after the onset of the hypotension was elevated. However, subsequent intradermal skin testing twelve weeks later did not identify a causal drug. Repeat mast cell tryptase at the time showed the same elevation, which led to the correct diagnosis of mastocytosis and a secondary diagnosis that the patient's hypotension and cardiac arrest were the result of her spinal anaesthesia. If the serum tryptase is elevated during the event but no allergic agent can be identified, a further serum tryptase should be taken several weeks later to exclude a persistent elevation due to mastocytosis.
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PMID:Pseudoanaphylaxis. 1718 2

Determination of serum mast cell tryptase (MCT) is becoming more widely used in diagnosing allergic reactions involving mast cells. It can help evaluate the allergenic effects of drugs administered during anesthesia and the perioperative period. Until now, data about the role of tryptase in the body has not been clarified yet. Patients with elevated MCT levels should undergo further testing to find out the causative agent of a potential allergic reaction. Patients with normal tryptase concentration should also undergo further diagnosis if they manifest clinical symptoms of a severe anaphylactic reaction.
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PMID:Tryptase in diagnosing adverse suspected anaphylactic reaction. 2321 4


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