leukotriene-e4 and Postoperative-Complications

Post-anesthesia anaphylactic reactions or those seen during drug provocation tests with a systemic clinical reaction may be confirmed by the sequential release into blood of plasma histamine, tryptase and leukotriene C4 and into urine of urinary methylhistamine and leukotriene E4.

Topics: Acetaminophen; Anaphylaxis; Anesthetics; Aspirin; Biomarkers; Chymases; Drug Hypersensitivity; Histamine; Humans; Leukotriene C4; Leukotriene E4; Postoperative Complications; Serine Endopeptidases; Tryptases

A protocol has been produced for the study of anaphylactic accidents that occur post-operatively that allows definition of the anaphylactic origin, and so reactions that are mediated by IgE in post-operative accidents. This protocol occurs in two stages, the first is done in the minutes and hours that follow the anaphylactic accident, and the second a month or 6 weeks afterwards. At first, we evaluate the sequential study of the liberation of the mediators of anaphylaxis, plasma histamine, serum tryptase, urinary methylhistamine and, more recently, leucotriene E4. The second study is devoted to reactions that are mediated by IgE, essentially, specific serum IgE, tests of activation of basophils by flow cytometry, measurement of leucotriene C4 and skin tests. A study on 16 subjects has evaluated and validated the protocol and shown a significant level of correspondence of results between the sequential measurement of mediators on one hand and on the other the search for IgE-mediated reactions every time that there was an anaphylactic reaction.

Topics: Adolescent; Adult; Aged; Anaphylaxis; Anesthetics; Basophils; Child; Chymases; Clinical Protocols; Creatine; Drug Hypersensitivity; Female; Gelatin; Histamine Release; Humans; Immunoglobulin E; Leukotriene C4; Leukotriene E4; Male; Methylhistamines; Middle Aged; Muscle Relaxants, Central; Plasma Substitutes; Postoperative Complications; Serine Endopeptidases; Skin Tests; Succinates; Tryptases

Lipid peroxidation and enhanced arachidonic acid metabolism is activated after blood-brain cell contact. Previous studies have indicated that cysteinyl-leukotrienes (cys-LT) have the capacity to constrict arterial vessels in vivo and in vitro suggesting their involvement in the pathogenesis of cerebral vasospasm. The purpose of this study was to measure the amount of cyst-LT in the cerebro-spinal fluid (CSF) in correlation with transcranial Doppler findings (TCD) in patients with aneurysmal subarachnoid haemorrhage (SAH). In all patients early surgery was performed. In the first cisternal CSF-sample which was already collected intra-operatively an initial peak of cys-LT was detected, followed by decreasing amounts of cys-LT during the next 5 days. The CSF-levels of immunoreactive cys-LT were significantly higher in those patients who showed signs of vasospasm on transcranial Doppler sonography (TCD) (p < 0.001). Normalization of TCD values was accompanied by decreasing levels of CSF-cys-LT. We found a significant correlation between the amounts of immunoreactive cys-LT in cerebrospinal fluid and cerebral vasospasm measured by TCD.

Topics: Adult; Aneurysm, Ruptured; Blood Flow Velocity; Brain; Chromatography, High Pressure Liquid; Cysteine; Enzyme-Linked Immunosorbent Assay; Female; Humans; Intracranial Aneurysm; Leukotriene C4; Leukotriene D4; Leukotriene E4; Leukotrienes; Male; Middle Aged; Postoperative Complications; Subarachnoid Hemorrhage; Ultrasonography, Doppler, Transcranial