| Popis: |
In the interventional suite, procedures like fistulograms, angioplasties, or thrombectomies require the use of radiocontrast media (RCM). These RCM however may evoke adverse reactions in patients. These reactions are classified as immediate or delayed. The immediate reactions can be further classified as allergic-like or physiologic. Clinically, allergic-like and anaphylactic reactions are indistinguishable and present as a true allergic reaction. The exact pathogenesis of allergic-like reactions is not well-known. Physiologic reactions are secondary to the physiochemical properties of the RCM. Delayed reactions are typically T cell-mediated. There are certain precautions that must be taken to prevent a recurrent allergic-like reaction in patients with a prior history of a reaction. Premedication with corticosteroids with or without antihistamines has been adopted as one such measure. The use of a structurally different RCM (compared to the culprit agent) has also been recommended. In spite of these precautions, breakthrough reactions can occur. The interventionalist should always be vigilant for early manifestations of such reactions, be aware of common clinical presentations, and be well versed in their management. Iodide mumps is a peculiar reaction that is treated by dialysis in dialysis dependent patients. Delayed reactions are predominantly dermatological and self-limited though serious skin reactions can occur. |
