[Evaluation of the activities and value of allergo-anesthetic consultation at the University Hospital Center of Nice 1985-1991].
Life-threatening accident during anesthesia scarcely happen but the consequences may be dramatic. We report our experience of an allergo-anesthesia consultation created since 1985 in Nice hospital. 452 patients have been investigated: 1) 109 for life-threatening anaphylactic and anaphylactoid drug reactions. They have been investigated by: skin tests intradermal reactions (IDR) and prick tests with substances used during anesthesia (drugs and latex) and for all the muscle relaxants; the radioabsorbent test (RAST) for the muscles relaxants, propofol and latex; the human basophilic degranulation test (HBDT) for all the other drugs. We used the imputability decision table to classify the reactions. When anaphylaxis diagnosis was established (14) an "allergy card" was given to patients which identified the drugs to which they had a positive reaction. 62 patients have presented an anaphylaxis: 57 due to muscle relaxants (37 due to suxamethonium), 4 to latex and 1 to a gelatin. Patients were subsequently contacted and 50 of the 58 have responded. 18 of these patients have received 22 new anesthesias. Without exception, the advises to avoid a drug have been followed, 17 patients have a positive reaction to a muscle relaxant. In four of these, another muscle relaxant (skin test negative) was used without any trouble. For the other 13 who had shown a cross reactivity, all the muscle relaxants had been rejected and another anesthetic technique have been used: local anesthesia (3 cases), epidural (2 cases) associated or not with narcotics (propofol, midazolam), general anesthesia (propofol, midazolam, droperidol, phenoperidine). These drugs were all skin test negative.(ABSTRACT TRUNCATED AT 250 WORDS)
Occelli
G
G
Département d'Anesthésie-Réanimation, Hôpital St-Roch, Nice.
Amedeo
J
J
Raucoules
M
M
Cassuto
J P
JP
Grimaud
D
D
D000707:Anaphylaxis / Q000139:chemically induced / Q000453:epidemiology; D000758:Anesthesia / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects; D002917:Chymopapain / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005602:France / Q000453:epidemiology; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D012017:Referral and Consultation / Q000706:statistics & numerical data
D000779:Anesthetics, Local; D002917:Chymopapain
Bilan d'activité et intérêt d'une consultation d'allergo-anesthésie au CHU de Nice de 1985 à 1991.