[Undesirable reactions to local anesthetics and their treatment]
van Beek, H
HERO ID
4946406
Reference Type
Journal Article
Subtype
Letter
Year
1986
Language
Dutch
PMID
| HERO ID | 4946406 |
|---|---|
| Material Type | Letter |
| In Press | No |
| Year | 1986 |
| Title | [Undesirable reactions to local anesthetics and their treatment] |
| Authors | van Beek, H |
| Journal | Nederlands Tijdschrift voor Geneeskunde |
| Volume | 130 |
| Issue | 3 |
| Page Numbers | 131 |
| Abstract | Following the article by Kerkkamp et al. (1985; 2353-6)two questions came up. The first concerns calcium administered intravenously. In 1943 I had a lot to do with treatment of diphtheria and with minor accidents for which tetanus prevention was deemed necessary at the time: both with the respective serum. As a reaction, urticaria was often seen: type 1; they were called "serum sickness." This was treated with calcium gluconate iv with spectacular results: the patient had an enormous feeling of heat and a rapid regression of the severe itching. Later I saw one more time at the consultation hour (in between) a young man of about 23 years who had acutely got an attack of urticaria with a large bronchospasmus: the whole looked rather worrisome. Anamnestic there was no cause to be found. Also in this case, I have taken to the calcium gluconate with a fast result: after half an hour in the waiting room as a hiding place (what a horrible word) he could go home on his own feet. Question: does this product deserve a place in the therapeutic arsenal listed in the article? I am also curious about the frequency of these reactions: if I read this story like this, I would not dare to do even the smallest wound attachment under local anesthesia outside the hospital. In response to the comments from my colleague Van Beek, I would like to mention the following. The treatment of an anaphylactic reaction with calcium gluconate does not seem useful. In view of the severity, it is necessary to use an agent that is directly effective and treats threatening circulatory and respiratory symptoms. The means of first choice is adrenalin. 1 In theory, the administration of calcium is contraindicated, since calcium ions are necessary for the release of mediators from the manure and basophil cells. 2 A low serum calcium level reduces the release of the mediators from the manure and basophilic cells. 3 The patients described by colleague Van Beek probably did not have a type 1 allergic reaction. Serum serum is often seen when the serum is injected, which belongs to type III (complex-mediated). In the last patient described, no causative factors (antigens) can be identified, although there is still a histamine-induced reaction. A possible explanation for the beneficial effect after administration of calcium gluconate in the described patients might be due to the fact that with an acute rise in serum calcium levels the concentrations of the hormones aldosterone and cortisol and of the neurotransmitter ACTH in the serum are increased. 4 The frequency of type 1 reaction (anaphylaxis) when using local anesthetics of the amide type is extremely rare; no exact figures are given in the literature. The allergic reactions with the ester type are considerably more common. Only 1 of all reactions in the use of local anesthetics are allergic, 80 to 90 of type IV. 5 Use of local anesthetics is therefore justified, provided that the maximum doses are not exceeded. However, one must always realize that an anaphylactic reaction can occur, for which the therapeutic drugs must be available. |
| Pmid | 3951600 |
| Is Certified Translation | No |
| Dupe Override | No |
| Is Public | Yes |
| Language Text | Dutch |
| Keyword | Index Medicus; 1986) |
| Relationship(s) |
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