Rocuronium bromide induced anaphylaxis in a child -A case report-

Anaphylaxis or anaphylactoid reaction in pediatric patient during anesthesia is rare. We report a rocuronium induced anaphylactic reaction in a 33-month-old female. The patient was scheduled to undergo escharectomy due to injuries suffered from a major burn. Shortly after administration of rocuronium, the patient developed severe hypotension, tachycardia, and hypoxia. A similar reaction occurred after administration of rocuronium on subsequent anesthesia. She underwent uneventful anesthesia with volatile induction and maintenance of anesthesia with sevoflurane on her next 7 operations without using of muscle relaxant

Predicting the Loop Current dynamics combining altimetry and deep flow measurements through the Yucatan Channel

The Loop Current is the main mesoscale feature of the Gulf of Mexico oceanic circulation. With peak velocities above 1.5 m s–1, the Loop Current and its mesoscale eddies are of interest to fisheries, hurricane prediction and of special concern for the security of oil rig operations in the Gulf of Mexico, and therefore understanding their predictability is not only of scientific interest but also a major environmental security issue. Combining altimetric data and an eddy detection algorithm with 8 years of deep flow measurements through the Yucatan Channel, we developed a predictive model for the Loop Current extension in the following month that explains 74% of its variability. We also show that 4 clusters of velocity anomalies in the Yucatan Channel represent the Loop Current dynamics. A dipole with positive and negative anomalies towards the western side of the Channel represents the growing and retracted phases respectively, and two tripole shape clusters represent the transition phases, the one with negative anomalies in the center associated with 50% of the eddy separation events. The transition between these clusters is not equally probable, therefore adding predictability. Finally, we show that eddy separation probability begins when the Loop Current extends over 1800 km (~27.2°N), and over 2200 km of extension, eddy detachment and reattachment is more frequent than separation. These results represent a step forward towards having the best possible operational Loop Current forecast in the near future, incorporating near real-time data transmission of deep flow measurements and high resolution altimetric data

Bronchospasm and Anaphylactic Shock Following Lidocaine Aerosol Inhalation in a Patient with Butane Inhalation Lung Injury

Allergic reactions to local anesthetics are very rare and represent <1% of all adverse local anesthetics reactions. A 54-year-old man was admitted to the hospital in the winter because of shortness of breath. The patient reportedly had an inhalation lung injury due to butane gas fuel. On the fifth day, he developed an asthmatic attack and anaphylactic shock immediately after lidocaine aerosol administration to prepare for bronchoscopy to confirm an acute inhalational lung injury diagnosis. Cardiopulmonary resuscitation was performed immediately after respiratory arrest, and the patient was admitted to the intensive care unit intubated and on a ventilator. He was extubated safely on the third post-cardiopulmonary resuscitation day. These observations suggest that aerosol lidocaine anesthesia may cause airway narrowing and anaphylactic shock. Practitioners should be aware of this potential complication. We report on this case with a brief review of the literature

A Case of Propofol-Induced Oropharyngeal Angioedema and Bronchospasm

Propofol (2,6-diisopropylphenol) is an ultrashort-acting sedative agent with sedative and amnestic effects that is used not only for anesthesia but also for sedation during minor outpatient procedures and endoscopic examinations. Rare cases of anaphylaxis following propofol administration have been reported in the medical literature. Documentation of anaphylaxis is often lacking because the cause and effect relationship is often hard to prove. Only a minority of patients get referred for allergy testing to confirm the offending drug. Here we report a 74-year-old woman who had an anaphylactic reaction with severe oropharyngeal edema and bronchospasm for a few minutes after receiving propofol during endoscopic examination. An allergy skin test was positive for both propofol and soybean. Soybean in the intralipid is one component of propofol, and we concluded that this anaphylaxis was caused by soybean

Perspectives on Anaphylaxis Epidemiology in the United States with New Data and Analyses

Anaphylaxis incidence rates and time trends in the United States have been reported using different data sources and selection methods. Larger studies using diagnostic coding have inherent limitations in sensitivity and specificity. In contrast, smaller studies using chart reviews, including reports from single institutions, have better case characterization but suffer from reduced external validity due to their restricted nature. Increasing anaphylaxis hospitalization rates since the 1990s have been reported abroad. However, we report no significant overall increase in the United States. There have been several reports of increasing anaphylaxis rates in northern populations in the United States, especially in younger people, lending support to the suggestion that higher anaphylaxis rates occur at higher latitudes. We analyzed anaphylaxis hospitalization rates in comparably sized northern (New York) and southern (Florida) states and found significant time trend differences based on age. This suggests that the relationship of latitude to anaphylaxis incidence is complex

Moored observations of mesoscale features in the Cape Basin: characteristics and local impacts on water mass distributions

The eastern side of the South Atlantic Meridional overturning circulation Basin-wide Array (SAMBA) along 34.5°&thinsp;S is used to assess the nonlinear, mesoscale dynamics of the Cape Basin. This array presently consists of current meter moorings and bottom mounted Current and Pressure recording Inverted Echo Sounders (CPIES) deployed across the continental slope. These data, available from September 2014 to December 2015, combined with satellite altimetry allow us to investigate the characteristics and the impact of mesoscale dynamics on local water mass distribution and cross-validate the different data sets. We demonstrate that the moorings are affected by the complex dynamics of the Cape Basin involving Agulhas rings, cyclonic eddies and anticyclonic eddies from the Agulhas Bank and the South Benguela upwelling front and filaments. Our analyses show that exchange of water masses happens through the advection of water by mesoscale eddies but also via wide water mass intrusions engendered by the existence of intense dipoles. These complex dynamics induce strong intra-seasonal upper-ocean velocity variations and water mass exchanges between the shelf and the open ocean but also across the subantarctic and subtropical waters. This work presents the first independent observations comparison between full-depth moorings and CPIES data sets within the eastern South Atlantic region that gives some evidence of eastern boundary buoyancy anomalies associated with migrating eddies. It also highlights the need to continuously sample the full water depth as inter-basin exchanges occur intermittently and affect the whole water column.</p

Anaphylactic Shock A Form of Distributive Shock without Inhibition of Oxygen Consumption

Background: The pathophysiology of anaphylactic shock during anesthesia is incompletely characterized. It is described as distributive by analogy with septic shock (anaerobic metabolism, high tissue oxygen pressure [PtiO 2 ] values). The PtiO 2 profile and its metabolic consequences during anaphylaxis are not known. Methods: Ovalbumin-sensitized anaphylactic shock rats (n ‫؍‬ 11) were compared to nicardipine-induced hypotension rats (n ‫؍‬ 12) for systemic hemodynamics, PtiO 2 , sympathetic nervous system activation, skeletal muscle blood flow, and interstitial lactate and pyruvate concentrations using combined microdialysis and polarographic Clark-type oxygen probes. Results: In both groups, the time course and the magnitude of arterial hypotension were similar. The ovalbumin group but not the nicardipine group displayed decreased skeletal muscle blood flow (from 45 ؎ 6.2 ml ⅐ 100 g ؊1 ⅐ min ؊1 to 24.3