[Perioperative aspects of anaphylaxis]. / Az anafilaxia perioperatív vonatkozásai.

Anaphylaxis is a generalized, severe, life-threatening reaction, mostly with an allergic origin. Triggers are usually drugs, insect bites, poisons, contrast material and food. It is caused by various mediators (histamine, prostaglandins, leukotrienes etc.) released from mast cells, basophilic granulocytes. Histamine plays a central role in its creation. Immediate recognition and specific treatment instantaneously are essential for successful treatment. In severe conditions, the clinical features are very similar, regardless of their allergic/non-allergic origin. The incidence can vary over time and between patient populations. Its incidence is extremely variable, approximately 1/10 000 anaesthesia. Most studies cite neuromuscular blocking agents as the most common causative factor. In England, the results of the 6th National Audit Project revealed that the most common causes were antibiotics (1/26 845), followed by neuromuscular junction blocking drugs (1/19 070), chlorhexidine (1/127 698), and Patent Blue paint (1/6863). It occurs within 5 minutes in 66% of cases, 6-10 minutes in 17%, 11-15 minutes in 5%, 16-30 minutes in 2%, but usually within 30 minutes. Antibiotic allergy is a growing problem, especially to teicoplanin (16.4/100 000) and co-amoxiclav (8.7/100 000). The risk of anaphylactic shock should not be a determining factor in choosing the type of muscle relaxant drug. The patient's anaesthesia classification, physical condition, obesity, use of beta-blockers and ACE inhibitors influence the clinical characteristics. The initial symptoms can be extremely varied in terms of the effectiveness of the treatment, early recognition and commencement of therapy are the keys to success. Asking about a preoperative allergy history can reduce the risk and incidence of anaphylaxis. Orv Hetil. 2023; 164(22): 871-877.

Can we predict critical care mortality with non-conventional inflammatory markers in SARS-CoV-2 infected patients?

BACKGROUND: Severe COVID-19 disease is associated with multiple organ involvement,then failure and often fatal outcomes.In addition,inflammatory mechanisms and cytokine storms,documented in many COVID-19 patients,are responsible for the progression of the disease and high mortality rates.Inflammatory parameters,such as procalcitonin(PCT) and C-reactive protein(CRP), are widely used in clinical practice. OBJECTIVE: To evaluate the predictive power of non-conventional inflammatory markers regarding mortality risk. METHODS: In our prospective study 52 patients were followed for 5 days after admission to an intensive care unit immediately with severe SARS-CoV-2 infection.We compared leukocyte-,platelet antisedimentation rate (LAR, PAR),neutrophil lymphocyte ratio(NLR), CRP, PCT levels. RESULTS: In non-surviving(NSU) patients LAR remained largely constant from D1 to D4 with a statistically significant drop(p < 0.05) only seen on D5.The NSU group showed statistically significant(p < 0.05) elevated LAR medians on D4 and D5, compared to the SU group.NLR values were continually higher in the non-survivor group.The difference between the SU and NSU groups were statistically significant on every examined day.PAR, CRP and PCT levels didn't show any significant differences between the SU and NSU groups. CONCLUSIONS: In conclusion, this study suggests that LAR and NLR are especially worthy of further investigation as prognostic markers.LAR might be of particular relevance as it is not routinely obtained in current clinical practice.It would seem beneficial to include LAR in data sets to train prognostic artificial intelligence.