[Abugov]

Вроде ничего особо нового, но кажется полезным:

Emergency Pretreatment Feasible

“The most important finding of this study is that contrast-allergic patients with STEMI who receive emergency pretreatment and then undergo direct PCI for STEMI may not have adverse effects,” the study authors write. “Although this finding may be surprising to cardiologists, a large body of radiology literature suggests that repeat administration of contrast to contrast-allergic patients is rarely dangerous.”

Based on their experience, the investigators offer 6 recommendations:

* Clinicians should weigh the potential benefits of PCI against the risks of repeat contrast reaction, “recognizing that reactions range from minimal to severe or even life-threatening. For patients in whom contrast has caused cardiovascular or respiratory collapse, contrast-requiring emergency procedures should be undertaken only if the potential benefits are considerable.”
* During emergency PCI, it is “reasonable to give intravenous steroids, knowing that they will not prevent immediate reactions but might prevent or mitigate sustained or delayed reactions.”
* Nonionic contrast agents should be used.
* Intravenous H1 and H2 blockers are also reasonable, even though their value is unproved. However, H2 blockers cannot be given alone, because “unopposed H1 histamine receptor stimulation may result in . . . vasoconstriction of the coronary arteries.”
* While the value of montelukast has not been studied in relation to contrast allergy, “[a]naphylaxis is thought to be at least partly regulated by leukotrienes and might be inhibited by a leukotriene inhibitor.”
* Operators should know, or have on-hand, the protocol for immediate treatment for acute reactions including cardiovascular or respiratory collapse. Resuscitation equipment should also be available.