Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia
TL;DR: The histamine-related disturbances under anaesthesia were remarkable for their severity (even with small rises in histamine concentrations), for the prevalence of bradycardia, and for the absence of skin signs.
About: This article is published in The Lancet.The article was published on 1994-04-16 and is currently open access. It has received 136 citations till now. The article focuses on the topics: Antihistamine & Haemaccel.
Citations
More filters
01 Jan 1998
TL;DR: This chapter was written as a formalized interaction of a group of surgeons and basic scientists from various countries to address some contemporary issues in surgical research.
Abstract: This chapter was written as a formalized interaction of a group of surgeons and basic scientists from various countries to address some contemporary issues in surgical research. It was conducted as a conference through written questions. When we talk about consensus, we frequently, and paradoxically, mean totally different things. 1 H. Wulff proposed that we avoid this term altogether. We did not seek or achieve formal consensus; there was general agreement and clear disagreement on several issues.
11 citations
TL;DR: In this paper, the authors reported the successful use of high-dose phenylephrine in the treatment of mesenteric traction syndrome, which is a type of colorectal exposure during colonic or aortic surgery.
11 citations
TL;DR: Empfehlungen zur stadienabhangigen Akuttherapie anaphylaktoider Reak-tions wurden in einer interdisziplinaren Konsensuskonferenz erarbeitet und 1994 in der Zeitschrift „Der Anaesthesist“ publiziert.
Abstract: Allergische, IgE-abhangige und nicht allergisch bedingte, IgE-unabhangige Uberem pfindlichkeitsreaktionen konnen durch eskalierende Mediatorfreisetzung in eine Anaphylaxie munden. Unbehandelt geht die Anaphylaxie mit einer erheblichen Morbiditat (Schock, Multiorganversagen) und Letalitat einher und kann innerhalb weniger Minuten im exitus letalis enden. Schwere anaphylaktische Reaktionen konnen selbst unter adaquater Therapie progredient verlaufen, und es kann nach einer voruberge-henden Besserung zu einem erneuten Ausbruch der Symptomatik kommen; mit Spatreaktionen mus bis zu 12 Stunden nach dem initialen Ereignis gerechnet werden. Fur die Notfallbehandlung ist eine Unterscheidung zwischen IgE-abhangigen und IgE-unabhangigen anaphylaktoiden Reaktionen nicht erforderlich. Grundpfeiler der Sofortbehandlung bei Hypotension und Hypoxie sind: Ausschalten des mutmaslichen Auslosers, Offenhalten der Atemwege, 100%ige Sauerstoffzufuhr, intravaskulare Volumenexpansion und Katecholamine. Nach den Sofortmasnahmen erfolgen Uberwachung und Behandlung des Patienten mit anaphylaktischem Schock auf der Intensiv-station. Empfehlungen zur stadienabhangigen Akuttherapie anaphylaktoider Reak-tionen einschlieslich des anaphylaktischen Schocks wurden in einer interdisziplinaren Konsensuskonferenz erarbeitet und 1994 in der Zeitschrift „Der Anaesthesist“ publiziert [20].
11 citations
11 citations
01 Jan 2009
TL;DR: Second-generation antihistamines are preferred to their predecessors because of better benefit-to-risk ratios, and are not only more potent, but also have anti-allergic and antiinflammatory properties.
Abstract: Histamine (one of the key mediators released from mast cells and basophils), plays a major role in the pathophysiology of allergic diseases, including rhinitis, urticaria, asthma and anaphylaxis. Histamine exerts its effects through its interaction with one of four distinct receptors (H1, H2, H3, H4). In allergic disease, it is the H1 antihistamines which are of primary benefit, although H2 antihistamines may also play a therapeutic role. H1 antihistamines remain first-line medications for the treatment of allergic rhinoconjunctivitis and urticaria. Second-generation antihistamines are preferred to their predecessors because of better benefit-to-risk ratios. The newer antihistamines are not only more potent, but also have anti-allergic and antiinflammatory properties. Although they are more expensive than the traditional antihistamines, the cost is substantially offset by their superior efficacy and safety profile when used in recommended dosages.
10 citations
References
More filters
Journal Article•
[...]
2,147 citations
TL;DR: 80 reports of randomised clinical trials in four leading general medical journals were reviewed and the reporting of the methodology of randomisation was inadequate, and the handling of comparisons of baseline characteristics was inadequate.
473 citations
TL;DR: The electrocardiographic changes consistent with ischemia during the 4 day perioperative period were documented and characterized in 100 patients with or at risk for coronary artery disease undergoing noncardiac surgery and postoperative ischemic episodes were the most severe.
321 citations
TL;DR: Pancuronium is suggested to be the least likely currently available agent to provoke a major anaphylactoid reaction and Predisposing factors in patients sensitive to muscle relaxants were: female sex, previous allergy and atopy.
Abstract: Sixty one patients who had suffered intra-operative anaphylactoid reactions were studied. Intradermal testing identified the causative agent in 84% of cases and, in 75% of these, muscle relaxants were responsible. Predisposing factors in patients sensitive to muscle relaxants were: female sex, previous allergy and atopy. The incidence of previous exposure was considerably higher than that reported in the literature. Pancuronium is suggested to be the least likely currently available agent to provoke a major anaphylactoid reaction.
130 citations
TL;DR: The effects of increasing concentrations of three opioids were studied on the release of preformed and de novo synthesized chemical mediators from human peripheral blood basophils and mast cells isolated from skin tissues or lung parenchyma.
Abstract: Opioids differ in their capacity to cause release of histamine. The effects of increasing concentrations of three opioids (morphine, buprenorphine, and fentanyl) were studied on the release of preformed (histamine and tryptase) and de novo synthesized (prostaglandin D2 [PGD2] and peptide-leukotriene C4 [LTC4]) chemical mediators from human peripheral blood basophils and mast cells isolated from skin tissues or lung parenchyma. Basophils released < 5% of their histamine content and did not synthesize significant amounts of LTC4 when incubated with any of the opioids. Mast cells showed markedly different responses to the three opioids. Morphine (10(-5)-3 x 10(-4) M), in a concentration-dependent manner, induced histamine and tryptase release from skin but not from lung mast cells, up to a maximum of 18.2 +/- 1.9% and 13.0 +/- 4.1 micrograms/10(7) cells, respectively. Morphine did not induce de novo synthesis of PGD2 from skin mast cells. Buprenorphine (10(-6)-10(-4) M), in a concentration-dependent manner, caused histamine and tryptase release from lung but not from skin mast cells, to a maximum of 47.6 +/- 7.2% and 35.1 +/- 13.6 micrograms/10(7) cells, respectively. Buprenorphine also induced de novo synthesis of PGD2 and LTC4 from lung mast cells. Fentanyl (10(-5)-10(-3) M) did not induce histamine and tryptase release or the de novo synthesis of PGD2 or LTC4 from any mast cells. Histamine release caused by buprenorphine from lung mast cells was slow (t1/2 = 11.2 +/- 3.6 min) compared with that induced by morphine from skin mast cells (t1/2 < 1 min, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
113 citations