Allergies to Anesthetics and Pain Medications: Key Considerations

Allergic Reactions to Anesthetics and Analgesics

Hello, doctor.
I would like to undergo a colonoscopy for screening.
I have previously received Kenacort (triamcinolone) injections for ulnar and radial pain, which were administered into the tendon, but it resulted in a painful reaction (more painful than before).
Does this count as an allergy? Can I receive pain relief injections like ketorolac or other analgesics? The doctor mentioned that if I am concerned about allergies, I could first receive an antihistamine injection (dexamethasone).
Is there any risk or side effects associated with this injection? Additionally, can I use Buscopan or Busacon? Is there a risk of allergic reactions to these medications? What about other medications similar to Demerol? Are they suitable for me, and is there a risk of allergic reactions? Given my previous reactions to medications, should I be concerned about allergies to anesthetics as well? I also have a history of arrhythmia, palpitations, chronic bronchitis, bronchiectasis (bilateral), and I cough up thick phlegm daily.
I have renal atrophy and stones, as well as thyroid nodules.
Am I a suitable candidate for sedation? I have never undergone general anesthesia, only local anesthesia for tooth extraction, eyelid surgery for a chalazion, and possibly nasal polyp removal.
Can these concerns be addressed in advance? I would appreciate your assistance in answering these questions.
Thank you.

Li Ayi, 50~59 year old female. Ask Date: 2017/10/09

Dr. Lin Xiuying reply Anesthesiology

Hello, regarding your questions, I can only respond as follows: 1.
The issue of swelling and pain after injecting Kenacort into the tendon may be related to an allergic reaction, but a direct assessment on-site is necessary for an accurate response.
2.
Kenacort and Keto are different types of medications.
However, some individuals may indeed have allergies to Keto, but the results can only be determined after administration.
Therefore, unless there is a known allergy to similar analgesics, whether to avoid them entirely remains a topic for discussion.
The same concept applies to other related medications like Buscopan and Demerol, although they are not of the same class.
3.
Patients with underlying diseases undergoing painless procedures certainly carry a higher risk.
Since the extent of the disease varies, the level of risk and its implications should be assessed by a physician.
I recommend that the safety of the procedure, in addition to understanding the medical and medication history, is primarily dependent on the ability of healthcare personnel to respond promptly in case of any complications.
This is the fundamental principle! I hope this information is helpful.
Wishing you a smooth examination!

Reply Date: 2017/10/09

More Info

Understanding allergies to anesthetics and pain medications is crucial, especially for patients with a history of adverse reactions to medications. In your case, you mentioned experiencing pain after receiving Kenacort, which is a corticosteroid. While this reaction might feel like an allergic response, it is essential to differentiate between an allergic reaction and a side effect or exacerbation of the underlying condition. Allergic reactions typically involve symptoms such as hives, swelling, difficulty breathing, or anaphylaxis, whereas side effects may include increased pain or discomfort at the injection site without the immune system's involvement.

Regarding your concerns about receiving pain medications like ketorolac (Keto) or other analgesics, it is important to consult with your healthcare provider. If you have a known allergy to a specific medication, it is advisable to avoid it and inform your medical team of your history. In some cases, premedication with antihistamines (like dexa) may be recommended to mitigate the risk of an allergic reaction. However, all medications carry potential risks and side effects, and the decision to administer them should be made based on a thorough assessment of your medical history and current health status.

As for medications like Buscopan (hyoscine butylbromide) or Busacon, these are generally well-tolerated, but individual reactions can vary. It is essential to discuss any concerns about potential allergies with your healthcare provider, who can provide guidance based on your specific medical history.

Demerol (meperidine) and similar opioids can also pose risks, especially for individuals with a history of respiratory issues, such as chronic bronchitis or bronchiectasis, as they can depress respiratory function. Given your history of heart arrhythmias and chronic respiratory conditions, the use of opioids should be approached with caution, and alternative pain management strategies may be considered.

Regarding your suitability for sedation or anesthesia, it is crucial to have a comprehensive evaluation by an anesthesiologist. They will consider your medical history, current medications, and any potential risks associated with anesthesia. Preoperative assessments often include a review of your allergies, current health status, and any previous reactions to medications or anesthesia.

In summary, while you may have concerns about allergies to anesthetics and pain medications, it is essential to communicate openly with your healthcare team. They can help determine the safest and most effective pain management strategy for your upcoming colonoscopy. Additionally, if you have never undergone general anesthesia, discussing your concerns and any previous experiences with local anesthesia will help your anesthesiologist tailor the approach to your needs. Always prioritize safety and thorough communication with your medical team to ensure the best possible outcomes.

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