Primary Management – General

CT) Contrast Media Related

CT Contrast Media

  • Omnipaque 350 (500ml)
  • Visipaque 320 (100ml)
    • Iodixanol
  • Xenetics
  • lomerone
  • Ultravist

Premedication for RCM hypersensitivity

  • N/S 500ml IV,pheniramine 1@ (4mg)
  • Steroids
    • Dexamethasone 1@(5mg)
    • mPd (Salon 125mg inj. 40mg)

Severe ICM hypersensitivity

  • 12hr before, PO Pd 40mg or IV mPd 40mg+
    1hr before, IV mPD 40mg, Chlorpheniramin 1amp

Premedication for Renal failure

2022 ACR guideline https://www.allergy.or.kr/content/member/file/220418.pdf

  • GFR <30 or 30-44 with high risk
  • NS pre 1hr ~ post 3-12 hr
  • N-acetylcysteine: used for DM patient -> not recomended
  • Diuretics, theophylline, endothelin-1, fenoldopam -> not recommended

Extravasation

  • Observation with arm elevation
  • Cold compression (not sure)
  • Antihistamine (1st gen + 2nd gen + H2b)
    • 1st gen: Mequitazine 5mg 1T bid x7 days
    • 2nd gen: Levocetirizine 5mg 1T qd x7 days
    • Famotidine 1T bid, x7 days
  • Visit ER if color change, heating sense
  • Hrase 1500IU ?? no one attempted

MRI Contrast Media

  • Dotarem (Gadoterate)
  • Gadoviswt (Gadobutrol)

Pain

Muscle relaxant

Eperisone 50mg bid

Opioid

Fentanyl

  • Durogesic D-trans patch
    • 12mcg/hr
    • 25mcg/hr

Buprenorpine

  • Norspan patch
    • 5mcg/hr (= 3~4mcg/hr fentanyl)
    • 10mcg/hr (= 7-8mcg/hr fentanyl)