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airway muscles and airway obstruction; attenuation of the hypoxic ven-
tilatory response (about 30%); and unpleasant symptoms of muscle
weakness.
Finally, another study (osmag.net/spRFE6) found that patients who are
left to spontaneously recover from such blockade are 6 times as likely
to need reintubation within 48 hours of surgery. And a 2012 analysis
(osmag.net/zEZk8S) found that reintubation requiring admission to the
ICU was associated with a 90-fold higher risk for in-hospital mortality.
Dogma No. 3: You should always give an IV test dose of Ancef to
patients who've had anaphylactic reactions to penicillin, to make sure
they don't react. The idea is that if there is true cross-reactivity with
Ancef (cephalosporins), you'll see a small area of reaction with a test
dose of about 1cc IV, and this will guide you not to give the rest.
The reality: In a small percentage of patients, even a tiny dose of
cephalosporins could result in full-blown anaphylaxis. Hence the cur-
rent recommendation is to not give any cephalosporins to patients
with known IgE-mediated reactions to penicillin.
At least 300 patients (or about 0.001%) treated with penicillin die
from anaphylaxis each year. Interestingly, about 70% have had peni-
cillin previously without issue (osmag.net/Fhv4UU), and it's estimated
that the true cross reactivity with first-generation cephalosporins is
about 1% (osmag.net/qUN6Zt).
Allergies to penicillin are about 25% IgE-mediated and 75% non-IgE-
mediated (osmag.net/ysTVM7). IgE-mediated reactions can result in ana-
phylaxis, urticaria and angioedema. Since penicillin IgE reaction is an
all-or-nothing proposition, it won't matter if you give 1 cc or the whole
dose of Ancef. In 1% of patients it could result in full-blown anaphylax-
is. OSM
