Experiencia en el manejo de anafilaxia en un Departamento de Emergencias Pediátricas

Introducción: La anafilaxia es una reacción multisistémica potencialmente mortal; su reconocimiento temprano y abordaje oportuno son fundamentales. La variabilidad de presentación y gravedad requieren la utilización de criterios diagnósticos para la mejora de la atención en urgencias. Objetivo: Describir las características clínicas, criterios de diagnóstico y tratamiento de los pacientes con anafilaxia atendidos en un Departamento de Emergencias Pediátricas (DEP). Materiales y métodos: Revisión retrospectiva, descriptiva, de casos ingresados en el DEP de enero 2015 a diciembre 2020. Los criterios diagnósticos fueron aplicados por dos observadores emergentólogos evaluando la concordancia con el índice к de Cohen. Se utilizó estadística descriptiva: proporciones, medianas y rango intercuartílico. Resultados: Se aplicaron los criterios NIAID/FAAN a 65 historias clínicas con diagnóstico de egreso de anafilaxia encontrándose una concordancia de 0,64 (IC 95%: 0,41-0,88). De ellos, 35 (54%) cumplieron los criterios diagnósticos. El 66% (23/35) recibió adrenalina. La mediana de edad fue de 7 años (RIC: 3-11,5). Antecedente de asma en 9/35, atopia en 7/35 y anafilaxia previa en 7/35. Como factor desencadenante se constató consumo de medicamentos en 16/35, alimentos en 8/35. La estadía hospitalaria tuvo una mediana de 18 horas (RIC: 12-24). Conclusiones: Los resultados sugieren una brecha entre identificación precisa de los casos de anafilaxia y el tratamiento oportuno con adrenalina cuando se utilizan criterios estandarizados.

Introduction: Anaphylaxis is a potentially fatal multisystem reaction; early recognition and timely approach are essential. The variability in its presentation and severity requires the use of diagnostic criteria to improve emergency care. Objective: To describe the clinical characteristics, diagnostic criteria and treatment of patients with anaphylaxis treated in a Pediatric Emergency Department (PED). Materials and methods: This was a retrospective and descriptive review of cases admitted to the PED from January 2015 to December 2020. The diagnostic criteria were applied by two emergentologist observers; Cohen's к index was used to evaluate their agreement. Descriptive statistics were used: proportions, medians and interquartile range. Results: The NIAID/FAAN criteria were applied to 65 medical records with a discharge diagnosis of anaphylaxis, finding an agreement of 0.64 (95% CI: 0.41-0.88). Of these, 35 (54%) met the diagnostic criteria. 66% (23/35) received adrenaline. The median age was 7 years (IQR: 3-11.5). 9/35 had a history of asthma, 7/35 had atopy and previous anaphylaxis was noted in 7/35. As a triggering factor, medication consumption was found in 16/35, and food in 8/35. The hospital stay had a median of 18 hours (IQR: 12-24). Conclusions: The results suggest a gap between accurate recognition of anaphylaxis cases and timely treatment with adrenaline when standardized criteria are used.

Enfrentamiento de la anafilaxia en el servicio de urgencia / Approach of Anaphylaxis in the emergency room

La anafilaxia es una reacción en su mayoría de hipersensibilidad tipo I, que estimula la activación generalizada de mastocitos, y provoca un cuadro clínico multisistémico que puede ser fatal. Se estima que tiene una incidencia de 0,03-0,1% y una prevalencia de vida de 0,5-2% en la población general. Generalmente, la reacción inmunológica ocurre posterior a la ingesta de alimentos, uso de medicamentos o picaduras de insectos, pero también se han descrito mecanismos no inmunológicos (no IgE) que actúan directamente sobre los mastocitos, llamadas en la literatura "reacciones anafilactoideas". La anafilaxia fue descrita por Paul Portier y Charles Robert Richet en 1902 en perros, los cuales desarrollaban esta reacción posterior a la inyección repetida de veneno de anémonas (medusas). Sin embargo, esta entidad no tuvo criterios diagnósticos ni pilares de manejo estructurado hasta el año 2006. En ese año en se publicó el segundo simposio de manejo de la anafilaxia, en donde se definieron criterios diagnósticos clínicos claros y el rol fundamental de la adrenalina en su manejo; la única droga que cambia el pronóstico del paciente.

Anaphylaxis is mainly a type I hypersensitivity reaction. It triggers a widespread activation of mast cells, causing a multisystemic clinical scenario that can be fatal. It is estimated to have an incidence of 0.03-0.1% and a lifetime prevalence of 0.5-2%. Most immunological reactions occur after food ingestion, medication, or insect stings, but non-immunological (non-IgE) mechanisms that act directly on mast cells, called Anaphylactoid Reactions, have been also described. Anaphylaxis was described by Paul Portier and Charles Robert Richet in 1902 in dogs, that developed this disease after repeated injections of anemones (jellyfish) venom. However, this entity didn't have established diagnostic criteria or an standarized management until 2006. In this year, the second anaphylaxis management sym-posium took place and clear clinical diagnostic criteria were defined. The fundamental role of adrenaline in its management was also established. The former is the only drug that has demonstrated to improve prognosis of the patient

Coherence and vitals of medicinal herbs, nutrients, and yoga in stress management and psychological stasis

When the time lows of the psychological body, about the human mind, there is a vital relationship between the psychological and somatic body leading to stress and mishaps. This could be a lack of coherence among significant components in the body, which are characterized by hormones such as cortisol and adrenaline that come into play. Cortisol and adrenaline are released when there is usually a response of fight or flight, where these hormones get ready to handle the body’s reaction, and when this happens properly, it yields stress. Stress occurs through all age groups across every ethnicity and population, as the functioning of the mind is very similar. Managing this emerging stress and anxiety condition could be done through the easy way of the modern system of medicine, allopathy. Alternatively, the traditional method comes in handy to maintain such a condition with hardly any long-term side effects. A few conventional techniques like the practice of yoga, support of the proper nutrients, and certain medicinal herbs are bent to see a change in the perspective of coping mechanisms that results in a stress-free environment within the human mind. Many patterns of practices are noticed that there are specific nutrients and supplements formulated with medicinal herbs with significant pharmacological properties and the ancient activity of yoga aid in stress management. Using and practicing regularly can help in an integrated caliber of living. This review article sheds information and collation on such significant medicinal herbs, nutrients, and renounced practices of yoga that play together in the balance of the human body to overcome the distress of the mind. Many studies have noticed that medicinal herbs, nutrients, and specific yogic asanas help handle stress and anxiety, giving a holistic living pattern.

Study of the potential toxicity of adrenaline to neurons, using the SH-SY5Y human cellular model

Abstract Prolonged overexposure to catecholamines causes toxicity, usually credited to continuous adrenoceptor stimulation, autoxidation, and the formation of reactive pro-oxidant species. Non-differentiated SH-SY5Y cells were used to study the possible contribution of oxidative stress in adrenaline (ADR)-induced neurotoxicity, as a model to predict the toxicity of this catecholamine to peripheral nerves. Cells were exposed to several concentrations of ADR (0.1, 0.25, 0.5 and 1mM) and two cytotoxicity assays [lactate dehydrogenase (LDH) release and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl tetrazolium bromide (MTT) reduction] were performed at several time-points (24, 48, and 96h). The cytotoxicity of ADR was concentration- and time-dependent in both assays, since the lowest concentration tested (0.1mM) also caused significant cytotoxicity at 96h. N-acetyl-cysteine (1mM), a precursor of glutathione synthesis, prevented ADR-induced toxicity elicited by 0.5mM and 0.25mM ADR following a 96-h exposure, while the antioxidant Tiron (100µM) was non-protective. In conclusion, ADR led to mitochondrial distress and ultimately cell death in non-differentiated SH-SY5Y cells, possibly because of ADR oxidation products. The involvement of such processes in the catecholamine-induced peripheral neuropathy requires further analysis.

A prospective descriptive study on emergency medicines used most frequently from the emergency medicine packs at Universitas Academic Hospital and the associated financial loss of expired emergency medicines

Resuscitation trolleys with equipment and medicines for emergencies are required in all clinical areas in hospitals. Emergency medicines kept separately are more likely to expire than non-emergency medicines, as these are generally used less frequently. An updated list of essential emergency medicines was implemented in 2016 at an academic hospital in central South Africa. The aim of this study was to determine the frequency of both the use and the expiry, with associated financial losses, of the emergency medicines on this list. Methods: A prospective, descriptive study was conducted over a six-month period in 2019. Forms accompanying the emergency packs were returned to the pharmacy whenever packs expired or were opened. These forms were collected and the type and quantity of medicines either used or expired were recorded. Results: In total, 168 of the returned forms were included. The most frequently used emergency medicines were adrenaline, sodium bicarbonate and Ringer's lactate. Adrenaline use was recorded on 52.8% and 25% of the forms from the adult/paediatric and neonatal emergency packs, respectively. Medicines that were never used included: betamethasone, Darrow's half-strength solution and most of the neonatal pack medications. Neonatal emergency medicine packs were rarely used and the neonatal fluid packs were never used. The total cost of the expired medicines was R7 960.29 (US$569.41 at the time of the study). Adrenaline was the medication that expired most frequently but the greatest financial losses occurred from expired sodium bicarbonate. Conclusion: The total financial losses were low but can be reduced further. The contents of the emergency packs should be reviewed to possibly reduce the amount of items used infrequently. Also, the removal of those items not recommended in emergency care guidelines could be considered. Ensuring the policy was followed of returning unused medicines close to expiry and redistributing these to high-use areas would further reduce wastage

A Comparative Study of Nebulized 3% Hypertonic Saline Versus Nebulized Adrenaline in The Treatment of Acute Bronchiolitis

Background: Acute bronchiolitis is the most common lower respiratory tract infection in young infants and young children. The respiratory syncytial virus is the commonest cause of bronchiolitis. Recently the role of nebulized 3% saline has come into focus. Nebulized adrenaline has also been suggested as another treatment option, its primary role being the reduction of mucosal edema, which is an important part of the disease pathology in bronchiolitis. Objective: To see the effects of nebulized adrenaline in comparison to nebulized 3% hypertonic saline in the treatment of acute bronchiolitis. Material & Methods:This was a randomized controlled trial, carried out in the Department of Pediatrics, Bangladesh Shishu Hospital and Institute from October 2017 to March 2020. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted with acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 3% nebulized hypertonic saline (group A=45) or to the nebulized adrenaline-1:1000 group (group B=45). Monitoring was done by respiratory distress assessment instrument (RDAI) score at 12 hours interval for 1st 24 hours and then 24 hourly till the patient was ready for discharge. The efficacy was determined by assessing clinical severity score/RDAI score and length of hospital stay. Data were analyzed using SPSS version-23.Results:The mean age was found 6.34±3.89 months in group A and 6.06±3.55 months in group B. The majority of patients were males in both groups. All patients had a cough, breathing difficulty, Ronchi, and chest indrawing in both groups. Changes in heart rate were 5.68±6.61/min in group A and 2.86±5.87/min in group B, which was significantly decreasing in group A than in group B. Mean clinical severity scores at 12 hours and at 24 hours were statistically significant (p<0.05). However, mean clinical severity scores at baseline, at 48 hours, at 72 hours, and at 96 hours were not statistically significant. The mean duration of oxygen therapy was found 15.00±5.36 hours in group A and 24.63±11.64 hours in group B. Which indicates that the duration of oxygen therapy was significantly higher in group B than in group A. Majority of the patients of group A and group B were discharged within 72 hours 39(86.7%) and 28(62.2%) respectively, which was statistically significant.Conclusions:Nebulization with 3% hypertonic saline significantly reduced clinical severity score and length of hospital stay in case of acute bronchiolitis in comparison to nebulized adrenaline.

Periarticular Infiltration (Bupivacaine, Adrenaline, Magnesium Sulphate And Dexmedetomidine) For Postoperative Analgesia In Total Knee Arthroplasty- A Cases Series Study

Background:Total knee arthroplasty is a major surgery associated with severe pain and delayed rehabilitation. Good quality analgesia with minimum side effects is required for post-operative rehabilitation andinfluences overall outcome of patients.Material And Methods:All patients were given spinal anaesthesia. Intraoperatively, all patients received periarticular infiltration with solution of bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate and normal saline. Post-operatively all patients received intravenous diclofenac sodium 75 mg 12 hourly. Postoperative pain using VAS score, sedation using Ramsay sedation score and hemodynamic parameters were observed.Result:The mean VAS score for pain was <2 during the first 48 hours and provided good analgesia to the patients. During the post-operative period hemodynamic parameters remained comparable to baseline and all patients were co-operative, oriented and tranquil. None of the patient developed any side effects.Conclusion:Local infiltration with bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate can be used along with intravenous diclofenac sodium in patients undergoing total knee arthroplasty and is effective, safe and reliable multimodal pain regimen.

Interpretation of European Academy of Allergy and Clinical Immunology guideline: Anaphylaxis (2021 update) / 中国小儿急救医学

Anaphylaxis is a clinical emergency that could be fatal.Pediatricians in China have insufficient understanding of pediatric anaphylaxis and lack of comprehending of diagnosis and treatment protocols or guidelines.As a regional guideline in 2021, the European Academy of Allergy and Clinical Immunology Anaphylaxis guideline updated, which focused on the initial management of anaphylaxis in the community, emphasized the importance of adrenaline autoinjectors and training for healthcare professionals, and provided evidence-based advices for clinical diagnosis and long-term management, complementing the World Allergy Organization anaphylaxis guidance 2020.

Interpretation of guideline on adrenaline autoinjector application: European Academy of Allergy and Clinical Immunology anaphylaxis guideline (2021 update) / 中华实用儿科临床杂志

Anaphylaxis is a hypersensitivity reaction that is rapid in onset, multi-system involved and can be fatal.Adrenaline is the first-line treatment of anaphylaxis.Adrenaline autoinjector is an important device in emergent situation.In European Academy of Allergy and Clinical Immunology anaphylaxis guideline updated in 2021, adrenaline autoinjector is systemically described and recommended.The following interpretation is focused on adrenaline autoinjector, including advantages, indications for prescription, pharmacokinetic data, dose and long-term management, aimed to enhance understanding of this device and standardize future application.

Regression of dark color in subterranean fishes involves multiple mechanisms: response to hormones and neurotransmitters

Organisms with source-populations restricted to the subterranean biotope (troglobites) are excellent models for comparative evolutionary studies, due to their specialization to permanent absence of light. Eye and dark pigment regression are characteristics of most troglobites. In spite of the advance in knowledge on the mechanisms behind eye regression in cave fishes, very little is known about pigmentation changes. Studies were focused on three species of the genus Pimelodella. Exemplars of the troglobitic P. spelaea and P. kronei were compared with the epigean (surface) P. transitoria, putative sister-species of the latter. Melanophore areas and densities are significantly lower in the troglobitic species. Evaluating the in vitro response of these cells to adrenaline, acetylcholine and MCH, we observed a reduced response in both troglobites to adrenaline. The same trend was observed with MCH, but not statistically significant. No response to acetilcholine was detected in all the three. Contrary to expectations, even though eye-regression in P. spelaea was much lower than in P. kronei, pigmentation regression was more advanced. Multiple mechanisms of loss showing a mosaic of traits in troglobitic fishes are discussed here.(AU)

Organismos com populações-fonte restritas ao biótopo subterrâneo (troglóbios) são excelentes modelos para estudos evolutivos comparativos, devido à especialização resultante do isolamento sob um regime seletivo particular, com ênfase na permanente falta de luz. A regressão do olho e da pigmentação são características dos troglobites. Apesar do avanço do conhecimento sobre os mecanismos subjacentes à regressão ocular em peixes de caverna, pouco se sabe sobre mudanças de pigmentação. Os estudos foram focados em três espécies do gênero Pimelodella. Exemplares das espécies troglóbias P. spelaea e P. kronei foram comparados com a epígea P. transitoria, provável espécie-irmã dessa última. As áreas e densidades dos melanóforos são significativamente menores nas espécies troglóbias. Avaliando a resposta in vitro dessas células à adrenalina, acetilcolina e MCH, observamos uma resposta reduzida em ambos os troglóbios à adrenalina. A mesma tendência foi observado com o MCH, mas não estatisticamente. Nenhuma resposta à acetilcolina foi detectada três. Contrariamente às expectativas, embora a regressão ocular em P. spelaea seja bem menor do que em P. kronei, a regressão na pigmentação foi mais acentuada. Múltiplos mecanismos de regressão, mostrando um mosaico de características em peixes troglóbios, são discutidos aqui.(AU)

Infiltración periarticular y ácido tranexámico tópico para control de pérdida sanguínea en artroplastia total de rodilla / Periarticular injection and topical tranexamic acid for blood loss control in total knee arthroplasty

Introducción La pérdida sanguínea durante el remplazo total de rodilla es una de las principales variables que influyen en los resultados de esta cirugía para lo cual se han implementado varios métodos para reducirla. Objetivo Cuantificar el cambio en el hematocrito y hemoglobina a las 24 horas postoperatorias en pacientes a quienes se les realizó reemplazo total de rodilla primario entre marzo del 2016 y agosto del 2017. Metodología Se realizó un estudio observacional a partir de una cohorte retrospectiva. Los criterios de inclusión fueron aquellos pacientes a quienes se les realizó reemplazo total de rodilla primaria con infiltración periarticular con bupivacaina con epinefrina, ketorolaco y morfina e intrarticular con ácido tranexámico. Se midieron hemoglobina y hematocrito pre y post operatorio, cálculo de pérdida sanguínea y transfusiones. Resultados Se analizaron un total de 159 reemplazos totales de rodilla (75 prótesis convencionales, 84 prótesis navegadas). El porcentaje de transfusión fue de 0,69% (1 paciente). La disminución del hematocrito promedio fue de 7,36% y la disminución de la hemoglobina de 2,49 gr/dl para una pérdida sanguínea calculada de 780ml. Se usó torniquete en 147 pacientes. Discusión La combinación de uso de torniquete, infiltración periarticular e intra articular de ácido tranexamico reduce la pérdida sanguínea y la necesidad de tranfusiones.

Background The blood loss during the total knee replacement is one of the main variables that influence the outcomes of this surgery, and several methods have been implemented to reduce it. The aim of the study is to quantify the change in haematocrit and haemoglobin at 24hours post-surgery in patients subjected to a total primary knee replacement at the Clinica Colombia between March 2016 and August 2017. Methods An observational study was conducted on a retrospective cohort. The inclusion criteria were those patients who had a total primary knee replacement with periarticular infiltration with bupivacaine, with adrenaline, ketorolac, and morphine, and intra-articular with tranexamic acid. Haemoglobin and pre- and post-operative haematocrit, blood loss calculation, and transfusions were measured. Results The analysis included a total of 159 total knee replacements (75 conventional prostheses, 84 navigated prostheses). The percentage of transfusion was 0.69% (1 patient). The decrease in mean haematocrit was 7.36%, and the mean decrease in haemoglobin was 2.49g / dl for a calculated blood loss of 780ml. A tourniquet was used in 147 patients. Discussion The combination of tourniquet use, periarticular, and intra-articular injection of tranexamic acid reduces blood loss and the need for tranfusions.

Hypertonic saline and adrenaline nebulization in the treatment of bronchiolitis: a retrospective study

Background: Bronchiolitis is the leading cause of acute illness and hospitalization in young children. There is limited role for diagnostic laboratory or radiographic tests in typical cases of bronchiolitis. Several large recent trials have revealed lack of efficacy of either bronchodilators or corticosteroids. Novel treatment like hypertonic saline and adrenaline nebulizations need to be evaluated for their efficacy.Methods: In this retrospective case control study, we included children aged between 6 months to 2 years admitted for bronchiolitis between August 2017 till July 2018. Each of the 45 children treated with adrenaline nebulisation was assigned a child who was given hypertonic saline nebulization only matched for age and duration of symptoms.Results: 45 children given adrenaline nebulization and 45 children given only hypertonic saline nebulization were compared. Mean duration of stay for children treated with adrenaline nebulization was 5.3 days and those given hypertonic saline was 4.8 days.' p value of 0.29.Conclusions:' Adrenaline nebulization did not shorten hospital stay in children admitted for bronchiolitis as compared to children given hypertonic saline.

Accidental injection of lignocaine with adrenaline in subarachnoid space: a case report

Drug errors are very common in medical field especially in anaesthesia where it’s the game of drugs. Here, we are presenting a case in which accidentally we injected lignocaine with adrenaline in place of heavy bupivacaine. Patient was of geriatric age group and posted for lower limb surgery under combined spinal epidural anaesthesia after placement of epidural catheter lumber puncture was done and 3ml of lignocaine with adrenaline was injected. After this patient develop complete sensory, motor blockade with hypotension. Level of block was up to T12 level patient was monitored for signs and symptoms of ransient neurologic syndrome (TNS) and anterior spinal artery syndrome for 24 hours. After 24 hours patient develop no complications and posted for surgery under general anaesthesia.so we have to be very careful about the labelling of drugs.

Effect Of Various Concentrations Of Lignocaine & Adrenaline Combination As Local Anesthetic On Ecg Parameters Of Patients Undergoing Dental Procedures

Background:Systemic absorption of local anesthetics occurs due to its local vasodilator effects. This leads to inhibi-tory action on the heart which is represented in the form of a decrease in conduction rate, the excitability of myocardi-um and force of contraction. The aim of the present study was to evaluate the effects of Lignocaine and adrenaline combinations on electrocardiogram undergoing dental procedures. Methods:This was a prospective, observational clinical study done in collaboration with the Department of Oral & Maxillofacial Surgery. All patients scheduled for oral surgeries under local anesthesia with Lignocaine 2% and adrenaline (1:80000 or 1:200000) combination of age 18 years or above 150 patients were included in the study. Patients with a history of hepatic, renal, cardiovascular and thyroid disorders were excluded from the study. A standard 12-lead ECG (25 mm/s) was recorded for each patient before administration of drugs (Basal), during the dental procedure (Intraoperative) and immediately after completion of surgical procedure. Results:There was no statistically significant difference seen between the Group A (Lignocaine 2% with 1:80000 adrenaline) and B (Lignocaine 2% with 1:200000 adrenaline) when the age, gender, PR interval, RR interval, mean QT & QTc dispersion, and heart rate were compared. Statistically significant difference was seen in comparing the mean QT & QTc interval, which was higher in Group A. ECG parameters in Group A and B showed a statistically significant decrease in PR interval, RR interval, QT interval, QTc interval, QT dispersion and QTc disper-sion, with the basal, was compared with intraoperative and postoperative findings. The increase in heart rate although was statistically significant in both the groups, it was always within normal limits suggestive of no clinical signifi-cance. There was a statistically significant decrease in QT and QTc interval, QT and QTc dispersion. The change in all these parameters was within the physiologic range. All these relevant parameters for cardiac arrhythmias did not show any arrhythmogenic potential of lignocaine-adrenaline combination in both the groups. Both the combinations are comparable with each other in terms of ECG parameters with changes more with group A suggesting the effect of in-creased concentration of adrenaline. The change in the heart rate and ECG parameters in both the study group might be attributed to the presence of adrenaline in the combination. No cardiovascular morbidities were observed except palpitation. Conclusion:Thus it can be very well concluded that the effects of lignocaine-adrenaline combinations on electrocardiographic parameters are minimal and clinically irrelevant. Both the combination appears to be safe to use in healthy individuals.

Adrenaline, transient receptor potential vanilloid 1 channel and substance P in rats with acute spinal cord injury complicated with lung injury / 第二军医大学学报

ObjectiveTo study the changes and significance of adrenaline, transient receptor potential vanilloid 1 (TRPV1) channel and substance P in rats with acute spinal cord injury (ASCI) complicated with lung injury. Methods Two hundred and twenty eight female Sprague-Dawley rats were randomly divided into sham operation group (sham group, n=90), ASCI group (n=108), bilateral adrenalectomy group (n=15), and ASCI after bilateral adrenalectomy group (n= 15). The ASCI model was established on the T10 spinal cord segment using a modified Allen's strike model (10 g, 25 mm). The sham group only exposed the T10 spinal cord, and the ASCI after bilateral adrenalectomy group was established 5 days after bilateral adrenalectomy. High-performance liquid chromatography was used to detect the changes of serum adrenaline. The pulmonary tissue specimens were collected from rats. Wet-to-dry lung weight ratio was used to detect the changes of pulmonary edema, and H-E staining was used to detect the pathological changes of lung tissue. The expression of TRPV1 protein in lung tissue was detected by immunohistochemistry and Western blotting. The contents of substance P in the lung tissue were detected by enzyme-linked immunosorbent assay. Results Serum adrenaline levels in the ASCI group were significantly higher than those in the sham group at 2, 6, 12, 24, 48, and 72 h after spinal injury (all P<0.01). The pulmonary edema and lung injury gradually aggravated in the ASCI group at 24, 48 and 72 h after spinal injury, and began to recover at 1 week. The expression levels of TRPV1 protein and substance P contents in ASCI group were significantly upregulated compared with the sham group at 24, 48, and 72 h after spinal injury (all P<0.05, P<0.01). The edema of lung tissue and pathological injury in the ASCI after bilateral adrenalectomy group were alleviated compared with the ASCI group 72 h after spinal injury. Conclusion Adrenaline may involve in the pathogenesis of pulmonary edema and lung injury in rats with ASCI, which may be related to the upregulation of TRPV1 and P substance expression. The pulmonary edema and lung injury after ASCI can be alleviated by adrenalectomy.

Angina after anaphylaxis treatment

@#Anaphylaxis is a life-threatening emergency, and adrenaline is the mainstay treatment for this condition. However, there have been a few reported cases of patients experiencing cardiovascular complications, such as myocardial infarction and coronary vasospasm, after its use. We highlight such a case in a young, healthy patient and the important differentials to consider.

Anafilaxia: estado del arte / Anaphylaxis: state of the art

RESUMEN La anafilaxia se define como una reacción de hipersensibilidad, sistémica, de instauración rápida y potencialmente fatal, con manifestaciones clínicas y severidad variable, que resulta de la liberación súbita de mediadores de mastocitos y basófilos. El diagnóstico de esta entidad es fundamentalmente clínico, basándose en los patrones de manifestación y la exposición a un posible detonante. Actualmente varios estudios indican deficiencias en la identificación y manejo de esta enfermedad, lo que genera un riesgo elevado de mortalidad. En esta revisión presentamos puntos prácticos del manejo e identificamos las principales consideraciones a tener en cuenta en el primer nivel de atención.

SUMMARY Anaphylaxis is defined as a systemic, rapid onset, and potentially fatal hypersensitivity reaction, with variable clinical manifestations and severity resulting from the sudden reléase of mast cell and basophil mediators. The diagnosis of this entity is fundamentally clinical, based on the patterns of manifestation and the exposure to a possible trigger. Currently several studies indicate deficiencies in the identification and management of this disease, which generates an increase in mortality. In this review we present practical points of management and identify the main considerations to be taken into account in the first level care.

Antivenom therapy: efficacy of premedication for the prevention of adverse reactions

Antivenoms or antitoxins have been effectively used for more than a century. During this time, these products have always proven to be highly effective in the treatment of infections and envenomations. However, antivenoms did not exhibit good safety results in their initial applications. After many improvements, antivenoms have substantially better safety profiles but still have some side effects. Due to the occurrence of adverse reactions, the practice of using premedication with the intent to decrease side effects has become accepted or mandatory in many countries. The drugs used for premedication belong to the histamine H1 antagonist, glucocorticoid and catecholamine groups. Currently, this practice is being questioned due to low or controversial efficacies in clinical assays. In this article, we discuss the causes of adverse reactions, the mechanisms of drugs that block the undesired effects and the results obtained in clinical trials. Although these three families of drugs could have positive effects on reducing adverse reactions, only adrenaline has demonstrated positive results in clinical assays.

Antivenom therapy: efficacy of premedication for the prevention of adverse reactions

Antivenoms or antitoxins have been effectively used for more than a century. During this time, these products have always proven to be highly effective in the treatment of infections and envenomations. However, antivenoms did not exhibit good safety results in their initial applications. After many improvements, antivenoms have substantially better safety profiles but still have some side effects. Due to the occurrence of adverse reactions, the practice of using premedication with the intent to decrease side effects has become accepted or mandatory in many countries. The drugs used for premedication belong to the histamine H1 antagonist, glucocorticoid and catecholamine groups. Currently, this practice is being questioned due to low or controversial efficacies in clinical assays. In this article, we discuss the causes of adverse reactions, the mechanisms of drugs that block the undesired effects and the results obtained in clinical trials. Although these three families of drugs could have positive effects on reducing adverse reactions, only adrenaline has demonstrated positive results in clinical assays.(AU)