Reacción de hipersensibilidad secundaria al uso de bloqueadores neuromusculares / Hypersensitivity reaction secondary to the use of neuromuscular blockers

Resumen: Introducción: La anafilaxia perioperatoria constituye una condición clínica potencialmente letal. La causa más frecuente se atribuye a los bloqueadores neuromusculares. Objetivo: Identificar la incidencia de reacciones anafilácticas secundarias al uso de bloqueadores neuromusculares. Material y métodos: Se realizó una investigación descriptiva, observacional, de corte transversal para evaluar la incidencia de reacciones anafilácticas secundarias al uso de bloqueantes neuromusculares. El estudio se realizó en el Hospital «Hermanos Ameijeiras¼ en el período comprendido entre enero de 2016 y diciembre de 2018. Resultados: Del total de intervenciones quirúrgicas electivas, 3,431 requirieron anestesia general y el uso de bloqueadores neuromusculares. Predominó el sexo femenino en 75% de los casos, el grupo etario de 60 años y más con 68 pacientes (32.7%), el estado físico ASA II, 98 pacientes (41.1%). La media del IMC fue de 22.7 ± 1.14. La media del tiempo quirúrgico fue de 190 ± 42.5 min. De todos los fármacos el más utilizado fue el atracurio en 90 pacientes (43.3%) seguido del vecuronio 79 (38.0%) y el rocuronio 39 (18.8%). El número de eventos adversos fue escaso. Sólo se encontraron cuatro, dos con atracurio (50%), uno con rocuronio y uno con vecuronio 25% respectivamente. Conclusiones: Se constató la presencia de reacciones anafilácticas por el uso de bloqueadores neuromusculares, mismas que se manifestaron en un corto período al inicio de la inducción. El atracurio presentó la mayor frecuencia y todas fueron de intensidad leve.

Abstract: Introduction: Perioperative anaphylaxis is a potentially lethal clinical condition. The most frequent cause is attributed to neuromuscular blockers. Objective: To identify the incidence of anaphylactic reactions secondary to the use of neuromuscular blockers. Material and methods: A descriptive, observational, cross-sectional investigation was conducted to assess the incidence of anaphylactic reactions secondary to the use of neuromuscular blockers. The study was carried out at the «Hermanos Ameijeiras¼ Hospital, in the period between january 2016 and december 2018. Results: Of the total elective surgical interventions, 3,431 required general anesthesia and the use of neuromuscular blockers. The female sex predominated with 75%, the age group of 60 years and over with 68 patients (32.7%), ASA II physical condition, 98 patients (41.1%). The average BMI was 22.7 ± 1.14. The mean surgical time was 190 ± 42.5 min. Of all the drugs the most used was atracurium in 90 patients (43.3%), followed by vecuronium 79 (38.0%) and rocuronium 39 (18.8%). The number of adverse events was low. Only four were found, two with atracurium (50%), one with rocuronium and one with 25% vecuronium respectively. Conclusions: The presence of anaphylactic reactions was observed with the use of neuromuscular blockers, which occurred in a short period at the beginning of induction. The atracurium presented the highest frequency and all were of mild intensity.

Establishment of High-throughput Model for Anaphylactic Reaction in Vitro and Evaluation of Potential Anaphylactogen Isoliensinine / 中国中医药信息杂志

Objective To establish a high-throughput evaluation model for anaphylactic reactions; To screen and identify potential anaphylactogens from TCM monomeric compounds.MethodsCell model of stably expressed MrgX2 was established. Recombinate plasmid pmCherry-C1-MrgX2 was transfected to HEK293 to establish cell line for screening model. MrgX2 agonist and antagonist were used to identify the validation and stability of the cell line. A small library consisting of 180 compounds was profiled by using a cell-based calcium mobilization assay to find novel compounds targeting the MrgX2 receptor. EC50 test, IC50 test, specificity validation and cytotoxicity evaluation were carried out to detect the function of the positive agonist.ResultsThe EC50 of C48/80 to MrgX2 model was 2.7 μg/mL and the IC50 of 2-APB (evoked by 10 μg/mL C48/80) was 46.29 μmol/L. The first generation cell model of MrgX2 was similar to the 20th generation, and the Z factor of MrgX2 cell model was 0.78. In the primary screening for agonist, isoliensinine was identified as a novel agonist targeting receptor MrgX2 with an EC50 of 4.5 μmol/L and IC50 of39.47 μmol/L. Moreover, isoliensinine was validated to activate MrgX2 receptor specifically without cytotoxicity. Conclusion A high-throughput evaluation method for anaphylactic reactions can be established in vitro through calcium mobilization assay. A potential anaphylactogen isoliensinine is identified and validated.

Scutellaria baicalensis Inhibits Mast Cell-Mediated Anaphylactic Reactions / 체질인류학회지

Mast cells play a critical role in the effector phase of immediate hypersensitivity and allergic diseases. Scutellaria baicalensis is a widely used herb in traditional oriental medicine with anticancer, antiviral, antibacterial and anti-inflammatory properties. However, the roles of Scutellaria baicalensis in mast cell-mediated anaphylactic reactions have not fully been investigated. In this study, we examined the influences of the methanol extract of Scutellaria baicalensis (MESB) on compound 48/80- or anti-dinitrophenyl (DNP) IgE-induced anaphylaxis-like response in vivo. To further prove these in vivo results, the inhibitory effect of MESB on mast cell activation was evaluated, focusing on the histamine release from rat peritoneal mast cells (RPMC). MESB inhibited compound 48/80-induced systemic anaphylaxis-like reaction, plasma histamine release and ear swelling response in mice. MESB also attenuated passive systemic and cutaneous anaphylaxis evoked by anti-DNP IgE. In in vitro experiments, MESB dose-dependently reduced histamine release from RPMC activated by compound 48/80 or anti-DNP IgE. Moreover, compound 48/80-elicited calcium uptake was suppressed in a concentration-dependent manner of MESB. Furthermore, MESB transiently increased the level of intracellular cAMP. From these results, it is suggested that MESB possesses effective anti-anaphylactic activity.

A Case of Anaphylactic Reactions to Isosulfan Blue Dye in A Cervical Cancer Patient / 대한산부인과학회잡지

The sentinel lymph node is defined as the first node of a regional lymphatic basin that receives the lymphatic drainage from a tumor, thus representing an elective site of lymph node metastasis. According to the sentinel lymph node hypothesis, histologically negative sentinel lymph nodes can guarantee the histological negativity of the remaining regional lymph nodes. These assumptions suggest that the sentinel node can be a suitable marker of regional lymph node status. Thus sentinel node biopsy may be a reasonable alternative to unnecessary pelvic lymph nodes dissection and a suitable method for limited control of early stage cervical cancer. To improve the sentinel node detection in surgical procedures, we investigated lymphatic mapping of sentinel lymph nodes with isosulfan blue dye (lymphazur 1%) and technetium-99m colloid albumin. We have made it a rule to inject 5 ml of isosulfan blue dye in the peritumoral area of cervix. It is reported that isosulfan blue dye has been safe and easily used in the detection of sentinel lymph node in melanoma, breast cancer and vulvar cancer. We experienced a case of anaphylactic reactions to isosulfan blue dye in cervical cancer patient, so we report it with a brief review of literature.

Anaphylactic reactions to hornet sting: Report of 2 cases.

Two case of hornet-sting reactions in two siblings were reported. The victims were boys of 5 and 3 years old; the elder boy had seven sting sites and the younger ond had 27 sites. Symptoms of anaphylaxis and painful sores together with abnormality of laboratory investigations appeared more severe in the younger victim, likely attributable to the greater number of stings. Treatment with parenteral antihistamine and corticosteroids concurrently with the correction of urine acidity gave good results.