Author/Editor		Košnik, Mitja; Bajrovič, Nisera; Mušič, Ema; Šuškovič, Stanislav
Title		Neželene reakcije po lokalnih anestetikih: vloga alergološkega testiranja
Translated title		Adverse reactions to local anesthetics: role of allergy testing
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 67, št. 3
Publication year		1998
Volume		str. 143-6
Language		slo
Abstract		Background. Local anesthetics (LA) allow many procedures to be performed safely and comfortably. Although generally well tolerated, patients frequently report allergy-like adverse reactions to these agents. We studied the utility of allergy testing with LA. Methods. In retrospective analysis of hospital files of patients referred to Clinical department of pulmonary diseases and allergy. Golnik, probable mechanisms responsible for adverse reactions were established. Patients were tested by means of skin and incremental subcutaneous challenges with LA. Thereafter questionnaires were sent to patients. Patients were asked about their further local anesthesias and adverse events. Results. In 20 months 57 patients (51 women) 44+-15 yeras old were referred for testing. In 4 patients there was an adverse reaction elicited by allergy testing, but they all tolerated another LA. Questionnaire was answered by 25 patients. 17 patients received LA after being tested (30 injections). Sixteen patients didn't report any adverse event while 1 patients reported adverse event which was different as adverse event before test (chest tightness). Conclusions. Most adverse events during local anesthesia are psychosomatic reactions. In the case of real anaphylaxis another drug used simultanously with LA is more probable cause. With allergy skin test and incremental challgne tests allowed the selection of at least one LA which was tolerated without immunological or toxic side effects in all patients.
Summary		Izhodišča. Lokalni anestetiki (LA) omogočijo ali olajšajo številne medicinske posege. Včasih pa se ob posegu v lokalni anesteziji pojavijo neželeni simptomi, ki so podobni alergijski reakciji. Želeli smo vrednotiti zanesljivost in koristnost alergološkega testiranja z LA. Metode. Retrospektivno smo analizirali popise bolezni bolnikov, ki so bili napoteni na Klinični oddelek za pljučne bolezni in alergijo na Golnik s sumom alergije za LA. Iz anmnestičnih podatkov smo opredelili verjeten mehanizem neželene reakcije. Bolnike smo testirali s kožnimi testi alergije z LA in obremenitvenim testom z LA. Z anketo smo nato ugotavljali, ali so bolniki po alergološkem testiranju še kdaj prejeli injekcijo LA in ali so imeli ob tem zaplete. Rezultati. V 20 mesecih smo testirali 57 bolnikov (51 žensk), starih 44+-15 let. Pri štirih bolnikih se je med testiranjem pojavila intolerančna reakcija, vendar so vsi štirje nato prenesli drug LA. Na anketo je odgovorilo 25 bolnikov. Skupina bolnikov, ki so odgovorili in ki niso odgovorili na anketo, se nista pomembno razlikovali glede na starost in vzrok testiranja in mnenje o mehanizmu zapleta. Sedemnajst bolnikov je po testiranju prejelo lokalno anestezijo (skupaj 30 injekcij). Šestnajst bolnikov ni imelo ob tem nobenih težav, ena bolnica pa je imela težave, ki so bile drugačne od tistih, zaradi katerih je bila napotena na testiranje (tiščanje v prsih). Zaključki. Večina neželenih reakcij pri posegih v lokalni anesteziji je psihogenih. Če je neželena reakcija prava anafilaksa, je verjetnejši vzrok drugo, hkrati uporabljeno zdravilo, in ne LA. Pri vseh bolnikih se z alergološkim in obremenitvenim testiranjem lahko ugotovi LA, ki ga bre imunološkega ali toksičnega zapleta prenesejo.
Descriptors		ANESTHESIA, LOCAL ANESTHETICS, LOCAL DRUG HYPERSENSITIVITY SKIN TESTS QUESTIONNAIRES