Anaphylactic/anaphylactoid reactions during cardiac surgery.
Over a 12-month period, 1,743 patients were retrospectively evaluated for anaphylactic/anaphylactoid reactions during cardiac surgery. Reactions to protamine, vancomycin, blood, and metocurine were observed in eight patients (0.46%). Baseline to reaction mean arterial pressures decreased from 81 +/- 9 mmHg to 50 +/- 7 mmHg (mean +/- SD; p less than 0.001), cardiac output increased from 4.6 +/- 0.6 L/min to 6.5 +/- 1.2 L/min (p less than 0.005), stroke volume increased from 49 +/- 11 to 83 +/- 22 ml/beat (p less than 0.02), and systemic vascular resistance decreased from 1.294 +/- 137 to 563 +/- 127 dyne/sec/cm-5 (p less than 0.001). Two patients developed pulmonary artery hypertension, while only one patient developed bronchospasm. Initial hypotension during anaphylactic/anaphylactoid reactions is due to decreased systemic vascular resistance, not myocardial depression.
Levy
J H
JH
Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA 30322.
D000707:Anaphylaxis / Q000139:chemically induced / Q000209:etiology* / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007432:Intraoperative Period; D011479:Protamines / Q000009:adverse effects*; D065227:Transfusion Reaction; D014403:Tubocurarine / Q000009:adverse effects / Q000031:analogs & derivatives*; D014640:Vancomycin / Q000009:adverse effects*
D011479:Protamines; D014640:Vancomycin; C032943:metocurine; D014403:Tubocurarine