By Jerrold H. Levy
This booklet presents anaesthetists with a pragmatic method of the popularity, figuring out, and administration of life-threatening reactions to anaesthesia and different medicines used in the course of surgical procedure and within the ICU
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Additional resources for Anaphylactic Reactions in Anesthesia and Intensive Care
Prostacyclin (Prostaglandin I2) M a s t cells in human lung and vascular endothelium synthesize prostacyclin during anaphylaxis in vitro, antagonizing many o f the effects o f t h r o m b o x a n e A 2 (Stenson and Parker, 1 9 8 3 ) . , 1 9 9 0 ) . , 1 9 7 7 ) . Longer-acting analogues o f prostacyclin (iloprost) have been used t o inhibit platelet aggregation (Kraenzler and Starr, 1 9 8 8 ) . 3 The action of any mediator on vascular responses is the result of effects on vascular endothelial cells and direct responses on vascular smooth muscle.
Effect on Regional Vascular Beds T h e effects o f histamine on specific regional vascular beds are variable. , 1 9 9 1 ) . Histamine's net effect on a given regional vascular bed is the result o f multiple actions on the smooth muscle and underlying endothelium (Figure 3 . 1 ) . H 2 receptors on vascular smooth muscle mediate constriction whereas ( H 2 receptors) mediate relaxation. 1 and 3 . 2 ) . , 1 9 9 1 ) . W h e n endothelium is removed, the vasculature reacts to histamine with a contractile or a dilatatory response depending on which o f the t w o histamine receptor subtypes predominates in the smooth muscle.
Receptor stimulation of vascular smooth muscle produces vascular contraction, whereas H 2 receptor stimulation produces relaxation. Stimulation of endothelial H 2 receptors releases endothelium-derived relaxing factor (EDRF) (which derives from L-arginine by the action of nitric oxide synthetase) or prostacyclin (PGI 2). EDRF (nitric oxide) activates guanylate cyclase (GC), which generates cGMP, whereas PGI 2 activates adenylate cyclase (AC), which generates cAMP. The heavy line represents the observed response to histamine predominantly in human coronary arteries, especially those affected by atherosclerotic vascular disease with impaired H!
Anaphylactic Reactions in Anesthesia and Intensive Care by Jerrold H. Levy