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A1139
October 20, 2008 2:00 PM - 4:00 PM Room Hall E2-Area N, |
| Plasma Leukotrienes Measurements for Diagnosis of Anesthetic Allergic Events. |
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Pierre Leturgie, Benoit Plaud, Ph.D., M.D., Jean-Louis Gerard, M.D., Jean-Luc Hanouz, Ph.D., M.D., Dominique Laroche, Ph.D., M.D. Anesthesie Reanimation, Centre Hospitalier Universitaire, Caen, NORMANDIE, France |
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Introduction: Diagnosis of anaphylactic reactions occurring during anesthesia is based on measurement of plasma histamine and tryptase concentrations, and skin tests at follow-up [1]. However , each of these markers don't reach a 100% sensitivity for differentiating anaphylactic and anaphylactoid reactions [2]. The increase of leukotrienes, neoformed mediators, synthesized as a result of an IgE-Antigen binding, would be more specific of anaphylactic reactions. Material and methods: After IRB approval, and written informed consent, plasma concentrations of leukotrienes C4, D4, E4 from 7 control patients were prospectively measured by ELISA test (Cell Com™, Beckman-Coulter™, Roissy, France), before and after an uneventful general anesthesia with neuromuscular blocking agents. These concentrations were compared with those of 11 patients who had presented a severe IgE-dependent reaction to NMBA (grade III-IV), documented by positive skin tests. The results are expressed as mean ± 1 SD. The comparisons were done with ANOVA and Mann-Whitney tests. Results : In the control group, the mean leukotrienes concentrations were 914 ± 118 ng/ml before anesthesia induction, 1061 ± 157, 740 ± 117, 723 ± 86, respectively at t + 30min, t + 6h, t + 24h after surgery. There was no significant difference (p = 0.09). In the patients group, the mean leukotrienes concentrations at t + 30min were 38170 ± 8489 ng/ml, and 26304 ± 3205 at 24h. The comparison of the two groups showed a significant difference at t + 30min (p < 0.001) and at t + 24h (p = 0.001). Discussion: These results showed that leukotrienes plasma concentrations are highly increased during IgE-dependent reactions. Furthermore, this increase lasts for 24 hours, comforting the recommendation to keep a watch for patients having presented anaphylactic reactions, for at least 24 hours. In conclusion, there is a significant and long-lasting increase of plasma leukotrienes in patients presenting severe hypersensitivity reactions. References : [1] Ann Fr Anesth Reanim 2002;21:73s-96s [2] Anesthesiology. 2003;99:536-45. Anesthesiology 2008; 109 A1139 |