[¿Anafilaxia perioperatoria? Serie de casos].

Alicia Méndez-Gómez, Nayeli Servín-Suárez, Héctor Carrillo-Murillo, Eduardo Torres-Rojo, Karla Korkowski-Uviña, Itzel Vianney Ochoa-García
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Abstract

Objective: Identify the causative agent of POH, to avoid re-exposure and assess the use of alternative treatment.

Methods: 10 cases of immediate POH are described, in all of them a history of previous surgical procedures, carrying out a 3-step protocol: 1st documenting the surgical record to identify exposures, 2nd performing skin and/or epicutaneous tests and 3rd searching for an alternative treatment. treatment if a new surgical procedure is required and in selected cases challenge tests.

Results: Of a total of 10 patients with immediate POH, tests were performed according to the case: neuromuscular blockers, anesthetics, opioids, NSAIDs, anti- biotics, diuretics, latex, isodine, and chlorhexidine; finding positive tests in 7 (70%) patients: in 4 (40%) neuromuscular blockers, one of them also positive for latex, in 2 (20%) anesthetics and finally finding a pharmacological alternative in 2 (2%) and recommending free operating room latex in 2 cases (20%), the rest (30%) were classified as related to the surgical procedure and medication management.

Conclusions: The study of POH is focused on ensuring safety in subsequent exposures, so in addition to identifying the causative agent, the role of the allergist also leads to a search for a safe alternative in patient management.

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[¿Anafilaxia perioperatoria ?casos系列)。
目的:查明POH的致病因素,避免再次暴露,评价替代治疗的使用情况。方法:本文描述了10例即时POH病例,所有病例均有既往手术史,执行三步方案:第一步记录手术记录以确定暴露,第二步进行皮肤和/或表皮试验,第三步寻找替代治疗方法。如果需要新的外科手术治疗,在选定的情况下挑战测试。结果:共有10例即刻POH患者,根据病例进行了检查:神经肌肉阻滞剂、麻醉剂、阿片类药物、非甾体抗炎药、抗生素、利尿剂、乳胶、异嘌呤、氯己定;7例(70%)患者检测阳性:4例(40%)神经肌肉阻滞剂,其中1例乳胶阳性,2例(20%)麻醉药,2例(2%)最终找到药物替代,2例(20%)推荐免费手术室乳胶,其余(30%)被分类为与手术和药物管理有关。结论:对POH的研究重点是确保后续接触的安全性,因此除了确定病原体外,过敏症专科医生的作用还导致在患者管理中寻找安全的替代方案。
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