Acute systemic reactions to intravascular contrast media--a planned approach.

Abstract

ABSTRACTAdverse reactions to intravascular contrast media (ICM) are common and carry a significant mortality rate. Major factors influencing incidence and severity include age, a history of asthma, heart disease, significant allergy, the type of investigation and the type of contrast agent used. Many mechanisms may be involved in producing ICM reactions, including histamine release, complement activation, antigen‐antibody reactions and direct cardiovascular effects. In order to deal with these unexpected emergencies, a carefully organised plan is essential. Patients with significant heart disease, asthma, allergy or a history of previous contrast reactions should be referred to major hospitals for their investigation. The use of forearm intravenous cannulae should be encouraged and patients must be carefully observed during ICM administration. Adrenaline is the mainstay of therapy and early intramuscular administration is recommended. Corticosteroids and antihistamines have no role in severe reactions, but bronchodilators and infusion of colloid solutions may be required.