Title Alergijske reakcije u perioperativnom razdoblju Title (english) Allergic reaction during the perioperative period Author Anita Stanišić Mentor Daniela Bandić Pavlović (mentor)Committee member Mladen Perić (predsjednik povjerenstva)Committee member DINKO TONKOVIĆ (član povjerenstva)Committee member Daniela Bandić Pavlović (član povjerenstva)Granter University of Zagreb Defense date and country 2018-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Alergijska reakcija je pretjerani imunološki odgovor na antigen kod prethodno senzibilizirane osobe. Postoje četiri osnovna tipa alergijskih reakcija koje uključuju humoralnu ili staničnu imunost. U perioperativnom razdoblju one su vrlo česta i ozbiljna komplikacija zbog brojnih lijekova i tvari koje anesteziolog upotrebljava, a vrlo je važno da na vrijeme prepozna i liječi anafilaktičku reakciju zbog neposredne životne ugroženosti. Upravo je zato tom tipu reakcije pridana najveća pažnja u radu. Anafilaktička reakcija prezentira se na različite načine, a najčešće kožnim, respiratornim i kardiovaskularnim simptomima. Neuromuskularni blokatori (NMB) smatraju se najčešćim uzročnikom alergijske reakcije u perioperativnom razdoblju jer oslobađanje histamina mogu izazvati neovisno i putem IgE protutijela. Drugi važan uzročnik je lateks zbog njegove široke uporabe i različitih tipova alergije do kojih može dovesti, od anafilaktičke reakcije do kontaktnog dermatitisa. Učestali uzročnik su antibiotici primijenjeni perioperativno, a mogu dovesti do imunološki ili neimunološki posredovane alergijske reakcije. Analgetici, osobito opioidi direktnim učinkom na mastocite oslobađaju histamin i dovode do ozbiljnih simptoma. Intravenski anestetici i plazma ekspanderi nisu toliko učestali uzročnici, dok su prave alergijske reakcije izazvane lokalnim i inhalacijskim anesteticima izuzetno rijetke. Nakon što se alergijska reakcija (anafilaktičkog tipa) prepozna liječi se po smjernicama koje uključuju prekid davanja lijeka za koji sumnjamo da je mogući uzročnik ili dodir s lateksom, intenzivnu respiratornu i kardiovaskularnu potporu, primjenu adrenalina, antihistaminika i kortikosteroida. Vrlo je važno provesti testiranje na moguće alergene „in vitro“ i „in vivo“ testovima, postaviti dijagnozu alergije i razgovarati sa pacijentom kako bi se izbjegli recidivi alergijske reakcije. Takva prevencija važna je za smanjenje morbiditeta i mortaliteta u perioperativnom razdoblju.
Abstract (english) An allergic reaction is an exaggerated immunological response to antigenic stimulation in a previously sensitized person. There are four main types of allergic reactions which include humoral or cell-mediated immunity. During the perioperative period, these reactions are common and serious causes of perioperative complications due to the numerous drugs anesthesiologists routinely administer. Therefore, anesthesiologists must be able to quickly recognize and treat anaphylaxis, the most life-threatening form of an allergic reaction. That is why this work focuses on anaphylaxis. Clinical manifestations of an allergic reaction vary widely. However, the most common symptoms are cutaneous, respiratory, and cardiovascular. Neuromuscular blocking agents (NMBA) are considered the leading drugs responsible for hypersensitivity reactions during anesthesia because they can cause IgE-mediated or non-IgE-mediated histamine release. The second most common cause of various hypersensitivity reactions, from anaphylaxis to contact dermatitis, is latex due to its widespread use. A frequent cause of immunologic or non-immunologic allergic reactions are antibiotics that are administered perioperatively. Opioids can elicit non-immunological histamine release from mast cells and cause serious symptoms. Intravenous anesthetics and colloids are not so common, while local and inhalational anesthetics are an extremely rare cause of allergic reactions. The treatment of anaphylaxis, after diagnosis, includes discontinuation of the presumptive drug and latex, aggressive pulmonary and cardiovascular support, as well as the administration of epinephrine, antihistamine, and corticosteroid drugs. It is very important to identify and confirm the offending drug using “in vitro” or “in vivo” tests and discuss the results with the patient to avoid recurrences. This kind of prevention is significant in avoiding morbidity and mortality during the perioperative period.
Keywords
alergijske reakcije
anafilaktička reakcija
neuromuskularni blokator
Keywords (english)
allergic reaction
anaphylaxis
neuromuscular blocking agents
Language croatian URN:NBN urn:nbn:hr:105:216054 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2018-12-27 09:07:30
