Anesthetics adverse drug reactions

Bronchospasm with clarithromycin occurred in a 44-year-old woman who had no history of respiratory allergies but had had adverse drug reactions to general and regional anesthetics and to ceftriaxone (14). After the administration of a quarter of the therapeutic dose the patient had dyspnea, cough, and bronchospasm throughout the lung. 

Adapted from Raj PP Handbook of regional anesthesia. New York Churchill Livingstone, 1985 Bartlett JD, Fiscella R, Jaanus SD, et al., eds. Ophthalmic drug facts. St. Louis Facts and Comparisons, 2005 Crandall DG. Pharmacology of ocular anesthetics. In Duane TD, Jaeger EA, eds. Biomedical foundations of ophthalmology. Philadelphia J.B. Lippincott, 1994 and Sobol WM, McCrary JA. Ocular anesthetic properties and adverse reactions, hit Ophthalmol Chn 1989 29 195-199. 

Correct estimates of the incidence of anesthetic deaths are difficult to obtain, since many deaths are multifactorial. Mortality due to anesthetic drugs is one in 10 000-20 000 (81). The adverse effects of anesthetics have been reviewed (82). Dose-related reactions are common and carry a low mortality, whUe non-dose-related reactions are less common and carry a high mortality. 

Typically, adverse events associated with the compounds discussed in this chapter occur as adverse reactions to drug therapy. However, adverse events can also occur after occupational exposure. This can be less obvious, as detailed occupational history taking is the exception rather than the rule in medical consultations. For certain agents—for example, antineoplastic drugs and volatile anesthetics—occupational exposure of health-care professionals is well recognized [1, 2 ]. Reports of occupational exposure to drugs covered in this chapter, and published in recent years, inspired a systematic literature review. 

Nervous system A 22-year-old woman developed paresthesia, a metallic taste, and hot flushes within 20 minutes of administration of intravenous spiramycin for toxoplasmosis during labor [80" ]. The adverse reactions were initially attributed to local anesthetic toxicity associated with epidural analgesia however, epidural catheter aspiration was negative, suggesting that the catheter was not placed intravenously and the temporal relation to spiramycin administration suggested that the drug was the more probable cause. 

Following the first description of allergy to a local anesthetic over 90 years ago, there was initially a steady stream of reports of reactions to the drugs consisting mainly of erythema or edema. With the introduction of the amide local anesthetics, the number of hypersensitivity reactions tapered off significantly, indicating that ester compounds were less well tolerated. Even today, however, reports of adverse reactions to local anesthetics occasionally appear, but the nature of the reactions cannot always be described... 

Drug overdose Dibucaine has been withdrawn from the market as an injectable spinal anesthetic, because of its adverse reactions profile, but it remains available as an over-the-counter topical formulation. Ingestion of a potentially lethal dose of dibucaine in a child has been reported [b9 ]. 

---