[Download] "Maximum Non-Reactive Concentration of Midazolam and Ketamine for Skin Testing Study in Non-Allergic Healthy Volunteers (Report)" by Anaesthesia and Intensive Care ~ Book PDF Kindle ePub Free
eBook details
- Title: Maximum Non-Reactive Concentration of Midazolam and Ketamine for Skin Testing Study in Non-Allergic Healthy Volunteers (Report)
- Author : Anaesthesia and Intensive Care
- Release Date : January 01, 2010
- Genre: Health & Fitness,Books,Health, Mind & Body,
- Pages : * pages
- Size : 234 KB
Description
Patients undergoing general or local anaesthesia are exposed to numerous drugs and other substances in a short period of time (e.g. neuromuscular blocking agents, hypnotics, opioids, antibiotics, local anaesthetics, blood products, latex, disinfectants). Administration of these substances can produce allergic reactions (immune mediated) and pseudo-allergic reactions (non-immune mediated). Anaphylactic reactions occur in one in 5000 to 20,000 anaesthetic procedures (1,2). The types of allergic anaphylaxis are subdivided into IgE-mediated and non-IgE-mediated reactions (3). In the subset of IgE-mediated reactions, prick and intradermal skin tests represent an important diagnostic tool. It is well established that intradermal tests are likely to give false-positive results more often than prick tests, especially for high drug concentrations (4). Most of the published reports have used serial decimal dilutions. These may not be accurate enough to define the highest concentration associated with the lack of a false-positive skin test. Diagnosis of anaphylaxis during anaesthesia is not always straightforward. Ideally, the diagnosis should rest upon several confirmatory tests rather than a single one. In the event of discrepancies between different tests, an alternative compound should be tested (5). When a patient with a previous allergy to anaesthetic drugs is investigated in an anaesthesia allergy centre, skin tests are performed for all the substances used in order to identify the culprit agent. One commonly used anaesthetic agent is midazolam. Thus midazolam is frequently tested, even though the incidence of midazolam allergy is low (0.57 to 0.62% of anaesthetic anaphylaxis) (6,7). In daily practice, midazolam is also tested as an alternative compound. Moreover, midazolam and other compounds are tested for research purposes (e.g. prevalence of positive skin tests to anaesthetic drugs) (8). In our centre, using the concentration recommended by current guidelines for midazolam (1 mg/ml for prick tests and 0.5 mg/ml for intradermal tests) (5,9) for 18 months, we observed a large number of positive intradermal tests (21% of 96 patients). Only one of the positive intradermal tests was confirmed by basophil activation tests. All prick tests performed for midazolam were negative. In a previous paper we reported a series of 39 patients allergic to medication other than anaesthetic agents, who were screened preoperatively for anaesthetic drugs substances. Eleven of them (28%) met the positivity criteria for midazolam intradermal tests (10). These high incidences for positive intradermal tests are disproportionately high compared with the incidence of anaphylactic reactions, bearing in mind that midazolam is used in a high proportion of patients who undergo surgery.
Post a Comment for "[Download] "Maximum Non-Reactive Concentration of Midazolam and Ketamine for Skin Testing Study in Non-Allergic Healthy Volunteers (Report)" by Anaesthesia and Intensive Care ~ Book PDF Kindle ePub Free"