[Tolerability of oral administration of carboxymethylcellulose in two patients presenting anaphylactic reaction after carboxymethylcellulose injection]. / Tolérance de la carboxyméthylcellulose par voie orale chez deux malades ayant développé une anaphylaxie à la carboxyméthylcellulose injectable.

BACKGROUND: Carboxymethylcellulose is a high-molecular-weight polysaccharide molecule used as a binding agent, for coating molecules and to increase the viscosity of formulations. It is present in a large number of pharmaceutical products but is also found in food and cosmetics. CASE-REPORT: We report two cases of patients who presented anaphylactic reactions immediately after localised corticosteroid injections; intra-articular for the first and intralesional for the second. Allergological testing for different corticosteroids and carboxymethylcellulose by means of prick-tests and intradermal testing indicated that the immediate hypersensitivity reaction was caused by the excipient, carboxymethylcellulose. The excellent safety of oral reintroduction of carboxymethylcellulose in a pharmaceutical preparation in these two patients confirmed that this large molecule is not absorbed through the digestive system. DISCUSSION: The avoidance list of products containing carboxymethylcellulose could be greatly reduced and limited to only injectable pharmaceutical preparations containing carboxymethylcellulose and to oral contrast media containing large quantities of carboxymethylcellulose.

Low-dose ketamine failed to spare morphine after a remifentanil-based anaesthesia for ear, nose and throat surgery.

BACKGROUND: Ketamine has been claimed to prevent acute opioid tolerance and hyperalgesia following acute exposure to opioids and its use has been proposed to decrease postoperative morphine consumption. METHODS: We conducted a randomized, double-blind, controlled study to evaluate the effect of intravenous (i.v.) ketamine on postoperative pain for 48 h after major ear, nose and throat (ENT) surgery. Thirty-one patients received i.v. ketamine 0.15 mg kg(-1) before induction and 2 microg kg(-1) min(-1) during anaesthesia, and 31 patients were administered placebo in a similar manner. Anaesthesia was standardized with remifentanil and propofol, but without nitrous oxide. Standardized postoperative analgesia included paracetamol, methylprednisolone and morphine administered via a patient controlled analgesia (PCA) device. RESULTS: Intra-operative remifentanil consumption was not different between the ketamine group (0.25 +/- 0.07 microg kg(-1) min(-1)) and the control group (0.22 +/- 0.07 microg kg(-1) min(-1)). In the postoperative period, both groups experienced an identical pain course evolution. Cumulative morphine consumption was not significantly different between groups: at 24 h it was 33.3 +/- 14.9 with ketamine and 31.9 +/- 15.3 mg in controls, at 48h it was 40.4 +/- 20.6 mg with ketamine and 42.5 +/- 25.9 mg in controls. CONCLUSION: Low-dose ketamine added to a remifentanil-based propofol anaesthesia did not reduce morphine consumption after major ENT surgery.