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New PDF release: Anaphylactic Reactions in Anesthesia and Intensive Care

By Jerrold H. Levy

ISBN-10: 075069064X

ISBN-13: 9780750690645

This e-book offers anaesthetists with a realistic method of the popularity, figuring out, and administration of life-threatening reactions to anaesthesia and different medications used in the course of surgical procedure and within the ICU

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Extra resources for Anaphylactic Reactions in Anesthesia and Intensive Care

Sample text

Heparin Heparin, a proteoglycan ionically bound to histamine in granules, is stored in h u m a n lung and cutaneous mast cells. T h e s e cells contain approximately 5 ixg o f heparin (molecular weight 6 0 , 0 0 0 daltons) per 1 , 0 0 0 , 0 0 0 cells (Metcalf, 1 9 8 2 ) . Heparin used in clinical practice is derived from both c o w and pig lungs because o f the high mast cell content. H u m a n basophils do not contain heparin as the proteoglycan; they contain chondroitin 4 and 6 sulfates, which possess a molecular weight o f 3 0 0 , 0 0 0 (Wasserman, 1 9 8 3 a ) .

1 9 8 2 ) . 1 Biologic Actions and Clinical Manifestations of Mast Cell/Basophil Mediators Mediators Biologic Actions Manifestations Histamine Smooth muscle relaxation Smooth muscle contraction Increases capillary permeability Positive inotropic Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Angioedema, urticaria, efflux of inflammatory cells Increased myocardial contractility Tachycardia Positive chronotropic ECF-A Eosinophil chemotaxis Inflammation NCA Neutrophil chemotaxis Inflammation Neutral proteases Proteolysis Inflammation Heparin Anticoagulant Coagulopathy Smooth muscle relaxation Smooth muscle contraction Stimulates mucus secretion Enhances basophil mediator release Inhibits platelet aggregation Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Broncho/rhinor rhea Potentiates reactions Leukotrienes (C 4, D 4, E 4) Smooth muscle relaxation Smooth muscle contraction Increases capillary permeability Stimulates mucus secretion Negative inotropic Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Angioedema, urticaria, efflux of inflammatory cells Broncho/rhinorrhea Myocardial depression, hypotension PAF Smooth muscle relaxation Smooth muscle contraction Increases capillary permeability Negative inotropic Vasodilation, hypotension Bronchospasm, coronary spasm, increased GI motility Angioedema, urticaria, efflux of inflammatory cells Myocardial depression, hypotension Neutrophil activation Platelet activation Newly synthesized Prostaglandin D 2 Neutrophil aggregation Platelet aggregation Not known ECF-A = eosinophilic chemotactic factor of anaphylaxis; GI = gastrointestinal; NCA = neutrophilic chemotactic factor; PAF = platelet-activating factor.

It is a peptidyl dipeptidase with 1 5 0 , 0 0 0 molecular weight that cleaves the t w o C-terminal a m i n o acids (phenylalanine and arginine) from bradykinin to inactivate them (Wiggins and C o c h r a n e , 1 9 8 4 ) . T h e active enzyme is present on the surface o f endothelial cells, primarily in the lung, the m a j o r site o f kinin metabolism (Erdos, 1 9 7 9 ; Pitt, 1 9 8 4 ) . T h e enzyme also cleaves the t w o Cterminal a m i n o acids to convert angiotensin I to angiotensin II, a potent vasoconstrictor.

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Anaphylactic Reactions in Anesthesia and Intensive Care by Jerrold H. Levy


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