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Adverse Response to Intravenous Drugs
Br.J. Anaesth. (1979), 51, 575
BOOK REVIEWS Cerebral Vascular Smooth Muscle and its Control (Ciba
R. Greenbaum
Adverse Response to Intravenous Drugs. By J. Watkins and
A. Milford Ward. Published by Academic Press. Price £8.20. This volume is the result of a Symposium held in the University of Sheffield Medical School, June 1977, at which invited participants discussed the frequency and mechanisms of adverse reactions to i.v. anaesthetic agents and plasma expanders. The book is divided into four sections dealing with clinical aspects and pharmacokinetics, incidence, mechanisms and management. The present volume should not be confused with a further symposium, "Adverse responses to intravenous agents", Sheffield, July 1978 (Watkins and Clarke, 1978). As the authors state in their foreword, the reactions and mechanisms discussed fall into the category of "qualitative abnormality in response". These reactions form a heterogeneous group, being neither predictable in relation to the normal pharmacology of the drug, related to dose, nor detectable in the normal toxicological screening during development and manufacture. Put more simply, immune responses are involved—probably. For those looking for an account of the problems involved in unexpected reactions to i.v. agents the book is helpful. However, the reader should not hope to discover definitively how immunology relates to anaesthesia. A glossary of
terms would be helpful; anaphylaxis, anaphylactoid, allergoid, allergy, histaminoid, sensitivity and hypersensitivity are used by some contributors as interchangeable terms, whereas other authors seem to imply specific meanings. Perhaps among those in the know these semantic problems are unimportant. However, for the tyro such jargon seems to raise resistance. It would be a pity, therefore, if Adverse Response to Intravenous Drugs is dismissed for
such reasons. The sections on plasma substitutes and histamine release, the latter by Lorenz and Doenicke from Germany, are valuable contributions. For various reasons plasma substitutes have never been as widely used in Britian as in Europe. Although the risk of a fatal reaction seems very small, the frequency of other unwanted responses to plasma substitutes is such that perhaps we should be grateful that Ringer-lactate infusion is still in vogue in Britian. Publication of a symposium is often criticized as being too little and too late and always anticipating next year's meeting. However, the present volume is the first of its kind and has appeared rapidly, although already overtaken by the next symposium, and its content is full. On balance, therefore, the book may be recommended for those interested in such problems. Leo Strunin REFERENCE
Watkins, J., and Clarke, R. S. J. (1978). Report of a symposium. Adverse responses to intravenous agents. Br. J. Anaesth., 50, 1159. Pain Relief in Labour (3rd edn). By D. D. Moir. Published (1978) by Churchill Livingstone. Pp. 122; illustrated; indexed. Price £1.95. This book is written primarily for midwives in the United Kingdom. It is accurate and up-to-date, as were previous editions. The opening chapter deals briefly with "History" and in an interesting manner. "Psychoprophylaxis and Allied Methods" are discussed succinctly. In "Analgesics, Sedatives, Tranquillizers—General Principles", and "Individual Sedatives", the author unequivocally sets out the important points and comments on the choice of drugs. "Inhalation Analgesia" is a thoroughly practical review of this important, and uniquely British, contribution to pain relief in labour. "Local Anaesthetics and Regional Anaesthesia" considers comprehensively the midwife's responsibilities, especially in relation to extradural block. "General Anaesthesia and Resuscitation" is the most important chapter of all, explaining in detail the midwife's vital role in helping the anaesthetist—help which can contribute so much to a reduction in mortality and morbidity. This short book is written clearly with a few wellproduced diagrams and tables. Dr Moir has mainly eschewed personal prejudice, although not hesitating to comment forcefully where necessary. This is a suitable text for any pupil midwife, whatever her anaesthetist teacher's preconceptions. Indeed, the sound advice in this book will be valuable to any anaesthetist concerned with this subject. Michael Rosen
Downloaded from http://bja.oxfordjournals.org/ at UB Giessen on May 5, 2015
Foundation Symposium No. 56-new series). Published (1978) by Elsevier, Excerpta Medica, North Holland. Pp. 400; illustrated;indexed. Price USS 35.50. This book contains a widely ranging review of much current research and thinking on cerebral blood flow, metabolism and regulating factors. Like many proceedings in similar symposia, there is a wide range of quality, digestibility and clinical relevance in the articles published. Much of the information is obtainable in fuller papers published by the same authors. The opening half of the book describes factors affecting cerebral vascular smooth muscle and blood flow; the second half is devoted to metabolism. Evidence presented suggests that oxygen may be most important in regulating arteriole diameter, but that capillaries are more likely to be controlled by the interaction of several factors, including K + and H + activity. The book provides a successful introduction to the new techniques in quantifying aspects of cerebral metabolism and leaves little doubt that this is an area where great advances will be made in the next few years. The (l4C) deoxyglucose technique has been used to show that the functional activity of the central nervous system regulates the local rate of energy metabolism and thence local blood flow is adjusted to meet the local metabolic demand. Nevertheless, many inhalation anaesthetics produce a blood flow in excess of metabolic requirements. The book contains useful information and deserves a place in selected reference libraries.
BOOK REVIEWS Cerebral Vascular Smooth Muscle and its Control (Ciba
R. Greenbaum
Adverse Response to Intravenous Drugs. By J. Watkins and
A. Milford Ward. Published by Academic Press. Price £8.20. This volume is the result of a Symposium held in the University of Sheffield Medical School, June 1977, at which invited participants discussed the frequency and mechanisms of adverse reactions to i.v. anaesthetic agents and plasma expanders. The book is divided into four sections dealing with clinical aspects and pharmacokinetics, incidence, mechanisms and management. The present volume should not be confused with a further symposium, "Adverse responses to intravenous agents", Sheffield, July 1978 (Watkins and Clarke, 1978). As the authors state in their foreword, the reactions and mechanisms discussed fall into the category of "qualitative abnormality in response". These reactions form a heterogeneous group, being neither predictable in relation to the normal pharmacology of the drug, related to dose, nor detectable in the normal toxicological screening during development and manufacture. Put more simply, immune responses are involved—probably. For those looking for an account of the problems involved in unexpected reactions to i.v. agents the book is helpful. However, the reader should not hope to discover definitively how immunology relates to anaesthesia. A glossary of
terms would be helpful; anaphylaxis, anaphylactoid, allergoid, allergy, histaminoid, sensitivity and hypersensitivity are used by some contributors as interchangeable terms, whereas other authors seem to imply specific meanings. Perhaps among those in the know these semantic problems are unimportant. However, for the tyro such jargon seems to raise resistance. It would be a pity, therefore, if Adverse Response to Intravenous Drugs is dismissed for
such reasons. The sections on plasma substitutes and histamine release, the latter by Lorenz and Doenicke from Germany, are valuable contributions. For various reasons plasma substitutes have never been as widely used in Britian as in Europe. Although the risk of a fatal reaction seems very small, the frequency of other unwanted responses to plasma substitutes is such that perhaps we should be grateful that Ringer-lactate infusion is still in vogue in Britian. Publication of a symposium is often criticized as being too little and too late and always anticipating next year's meeting. However, the present volume is the first of its kind and has appeared rapidly, although already overtaken by the next symposium, and its content is full. On balance, therefore, the book may be recommended for those interested in such problems. Leo Strunin REFERENCE
Watkins, J., and Clarke, R. S. J. (1978). Report of a symposium. Adverse responses to intravenous agents. Br. J. Anaesth., 50, 1159. Pain Relief in Labour (3rd edn). By D. D. Moir. Published (1978) by Churchill Livingstone. Pp. 122; illustrated; indexed. Price £1.95. This book is written primarily for midwives in the United Kingdom. It is accurate and up-to-date, as were previous editions. The opening chapter deals briefly with "History" and in an interesting manner. "Psychoprophylaxis and Allied Methods" are discussed succinctly. In "Analgesics, Sedatives, Tranquillizers—General Principles", and "Individual Sedatives", the author unequivocally sets out the important points and comments on the choice of drugs. "Inhalation Analgesia" is a thoroughly practical review of this important, and uniquely British, contribution to pain relief in labour. "Local Anaesthetics and Regional Anaesthesia" considers comprehensively the midwife's responsibilities, especially in relation to extradural block. "General Anaesthesia and Resuscitation" is the most important chapter of all, explaining in detail the midwife's vital role in helping the anaesthetist—help which can contribute so much to a reduction in mortality and morbidity. This short book is written clearly with a few wellproduced diagrams and tables. Dr Moir has mainly eschewed personal prejudice, although not hesitating to comment forcefully where necessary. This is a suitable text for any pupil midwife, whatever her anaesthetist teacher's preconceptions. Indeed, the sound advice in this book will be valuable to any anaesthetist concerned with this subject. Michael Rosen
Downloaded from http://bja.oxfordjournals.org/ at UB Giessen on May 5, 2015
Foundation Symposium No. 56-new series). Published (1978) by Elsevier, Excerpta Medica, North Holland. Pp. 400; illustrated;indexed. Price USS 35.50. This book contains a widely ranging review of much current research and thinking on cerebral blood flow, metabolism and regulating factors. Like many proceedings in similar symposia, there is a wide range of quality, digestibility and clinical relevance in the articles published. Much of the information is obtainable in fuller papers published by the same authors. The opening half of the book describes factors affecting cerebral vascular smooth muscle and blood flow; the second half is devoted to metabolism. Evidence presented suggests that oxygen may be most important in regulating arteriole diameter, but that capillaries are more likely to be controlled by the interaction of several factors, including K + and H + activity. The book provides a successful introduction to the new techniques in quantifying aspects of cerebral metabolism and leaves little doubt that this is an area where great advances will be made in the next few years. The (l4C) deoxyglucose technique has been used to show that the functional activity of the central nervous system regulates the local rate of energy metabolism and thence local blood flow is adjusted to meet the local metabolic demand. Nevertheless, many inhalation anaesthetics produce a blood flow in excess of metabolic requirements. The book contains useful information and deserves a place in selected reference libraries.