Anaphylactic Reactions in Anesthesia and Intensive Care by Jerrold H. Levy

By Jerrold H. Levy

This booklet presents anaesthetists with a pragmatic method of the popularity, realizing, and administration of life-threatening reactions to anaesthesia and different medicinal drugs used in the course of surgical procedure and within the ICU

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Effects on Vascular Permeability Histamine Hi receptor stimulation produces increased capillary permeability and leakage o f plasma proteins from various vascular beds. T h i s change in vascular permeability occurs in postcapillary venules and is produced by endothelial cell contraction and the formation o f junctional gaps o f up t o 1 |xm between adjacent endothelial cells (Hill, 1 9 9 0 ) . This represents a p h a r m a c o l o g i c effect o f histamine on the contractile state o f the endothelium rather than pathologic damage.

T h e body has an amazing capacity for metabolizing histamine Mediators of Anaphylactic Reactions I 35 to ensure that circulating levels remain relatively low. An elevation o f plasma histamine levels implies a significant release from storage sites. , 1 9 8 2 ) . T h u s , over the course o f 3 0 minutes, 2 1 0 , 0 0 0 nanograms were required to sustain this elevation. At an infusion rate o f 0 . 2 5 (xg/kg/min, a dose o f 5 0 0 , 0 0 0 ng was necessary to increase plasma histamine to 2 . 5 ng/mL.

T h e kinins can be formed from their larger molecular weight precursors. Both lipid-derived and peptide-derived mediators will be reviewed. , 1 9 7 7 ; Parker, 1 9 8 2 ; Serafin and Austen, 1 9 8 7 ) . Arachidonic acid is processed into cyclooxygenase products, including prostaglandins, t h r o m b o x a n e s , and prostacyclin, and 5-lipoxygenase products— leukotrienes. , 1 9 9 0 ) . T h e 5-lipoxygenase and cyclooxygenase products will be considered separately. , 1 9 9 0 ) . Leukotrienes are potent mediators, requiring only n a n o m o l a r concentrations to produce their effects.

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