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Resume Objectifs Presenter les differentes modalites de maitrise du risque allergique en anesthesie pediatrique. Type d’etude Analyse de la litterature. Methodes Recherche bibliographique, realisee a partir de la base de donnees Medline®, des publications parues en langue francaise et anglaise depuis 1982 a partir de mots-cles en format MeSH. Resultats L’incidence du risque allergique peranesthesique chez l’enfant est estimee a 1/7741 pour tous types d’anesthesies confondus. Ce risque est domine par l’allergie au latex avec une incidence de 1/10 159 anesthesies. Les facteurs de risque de sensibilisation au latex sont connus et la prevention primaire est efficace chez les patients a risque de sensibilisation au latex. A la difference de l’adulte, les curares sont rarement impliques chez l’enfant avec une frequence des reactions anaphylactiques de 1/81 275 pour tous types d’anesthesies confondus. Une classification clinique dite de Ring et Messmer permet de stratifier la gravite des reactions et de guider leur traitement. La symptomatologie clinique associe des signes cardiovasculaires, respiratoires et cutaneomuqueux selon un degre de gravite variable. Le traitement des reactions graves est fonde sur l’adrenaline associee a une expansion volemique. Le bilan allergologique fait partie integrante de la prise en charge du patient. Confronte a l’histoire clinique, il a pour but d’identifier le mecanisme physiopathologique de la reaction et le/la medicament/substance implique(e). Conclusion En anesthesie pediatrique, les reactions anaphylactiques dues aux curares sont rares alors qu’elles sont plus frequentes avec le latex. La maitrise de ce risque est, de fait, subordonnee en grande partie a l’eviction du latex.

Mastocytosis are characterized by an accumulation of abnormal mast cells in various tissues. Their incidence is estimated at 1/150,000 patients. Pure cutaneous mastocytosis which are mainly observed during childhood may resolve spontaneously during adolescence, whereas systemic mastocytosis involving one or more organs or tissues are more observed in adults. The initial event leading to mastocytosis is believed to be related to activating mutations in c-kit receptor, thus resulting in increased proliferation of mast cells precursors, migration in various tissues and degranulation leading to clinical signs. This nosologic entity does not belong to allergic diseases. Their perioperative management involves a multidisciplinary approach. The degranulation of mast cells with subsequent clinical symptoms can be triggered by psychological, chemical, traumatic, physical (rubbing, extreme temperatures...) agents. Avoiding these triggers should be realized whenever possible according to each patient. The premedication has not proven its efficiency. Tryptase measurement is part of the preoperative biological assessment. The clinical signs severity is related to the cardiovascular homeostasis disturbances (arterial hypotension, cardiovascular collapse, cardiac arrest). The cardiovascular symptoms do not correlate to the cutaneous versus systemic description of the disease. The drug of choice for the treatment of the severe cardiovascular signs is epinephrine associated to vascular loading. The aim of this literature review is to suggest the different modalities of perioperative care of patients with mastocytosis.

Care and therapy of patients experiencing an anaphylactic reaction should be known by the physicians working in the emergency medical unit or in pre-hospital care. The epidemiology of these reactions varies according to the countries. The main aetiologies are due to food, hymenoptera or drugs. The clinical scale proposed by Ring and Messmer aims to classify the reactions in 4 grades according to their severity and is useful to stratify therapy. According to the grade of the reaction, the drug of choice for the treatment of anaphylaxis is epinephrine associated to vascular expansion. Anaphylaxis during pregnancy is described. Patients who experienced an immediate hypersensitivity reaction should undergo an allergological investigation to prove the immune mechanism and to identify the culprit allergen. Reporting to the Drug Safety Monitoring Authorities when a drug is implicated should not be forgotten.

We report a grade III allergic hypersensitivity reaction occurring in a 72-year-old patient immediately after anaesthesia induction. Anaphylaxis to cisatracurium was diagnosed on clinical symptoms, biological tests and positivity of the cutaneous tests to this neuromuscular blocking agent. Five days after this allergological assessment, rocuronium, a muscle relaxant for which skin tests appeared negative was used during surgery without adverse effects. The authors underline the value of a detailed allergological assessment to identify the pathophysiologic mechanism, the culprit drug and to propose a safer alternate drug that might be used.

Resume Le but de ce travail a ete de comparer les effets rheologiques sanguins d'une perfusion de 500 ml de substitut plasmatique administree lors de l'induction anesthesique chez 60 patients ASA1, repartis au hasard apres tirage au sort, en 6 groupes de 10 patients. Chaque groupe recevait soit de l'albumine a 4 %, soit du dextran 40 a 3,5 %, soit du dextran 60 a 6 %, soit de l'hydroxyethylamidon 200 a 6 %, soit de la gelatine fluide modifiee, soit du Ringer lactate. Les prelevements sanguins ont ete effectues avant la perfusion, immediatement apres la fin de la perfusion, puis 3 et 24 heures apres. Les parametres biochimiques mesures ont ete la pression osmotique par cryoscopie, la pression oncotique par filtration, les protides totaux (methode du biuret) et le fibrinogene (methode de Von Clauss). Les parametres rheologiques etudies ont ete la viscosite plasmatique (viscosimetre capillaire), la viscosite sanguine a deux vitesses de cisaillement : 0,5 et 128 s−1 (viscosimetre de type Couette) et l'agregation des hematies avec etude des temps primaire et final d'agregation et des seuils de dissociation partielle et totale (erythroagregametre). Les mesures ont ete faites apres ajustement de l'hematocrite a 40 %. L'etude statistique a consiste en une analyse de variance intergroupe puis intragroupe, a l'aide du test non parametrique de Kruskal-Wallis. Le seuil de signification retenu a ete p