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.
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TL;DR: Treating anaphylactic reactions during anaesthesia is based on allergen administration interruption, epinephrine administration in a titrated manner based on symptoms severity, and on volume expansion.
Abstract: Anaphylactic reactions may be either of immune(allergy, usually IgE-mediated, sometimes IgG-mediated) or non-immune origin. The incidence of anaphylactic reactions during anaesthesia varies between countries ranging from 1/1250 to 1/13,000 per procedure. In France, the estimated incidence of allergic reactions is 100.6 [76.2-125.3]/million procedures with a high female predominance (male: 55.4 [42.0-69.0], female: 154.9 [117.2-193.1]). This predominance is not observed in children. In adults, the most frequently incriminated substances are neuromuscular blocking agents, followed by latex and antibiotics. The estimated incidence of allergic reactions to neuromuscular blocking agents is 184.0 [139.3-229.7]/million procedure. In most cases there is a close reaction between clinical symptoms and drug administration. When the reaction is delayed, occurring during the surgical procedure, a reaction involving latex, a vital dye, an antiseptic or a volume expanding fluid should be suspected. Reaction severity may vary. The most frequently reported initial symptoms are pulselessness, erythema, increased airway pressure, desaturation or decreased end-tidal CO2. Clinical symptoms may occur as an isolated condition, making proper diagnosis difficult. In some cases a cardiovascular arrest can be observed. Reaction mechanism identification relies on mediators (tryptase, histamine) measurement at the time of the reaction. In case of allergic reaction, the responsible drug can be identified by the detection of specific IgE using immunoassays or by skin tests performed 6 weeks after the reaction. Predictive allergy investigation to latex or anaesthetics in the absence of history of reaction should be restricted to at-risk patients. Premedication cannot prevent the onset of an allergic reaction. Providing a latex-free environment can be used for primary or secondary prevention. Treatment is based on allergen administration interruption, epinephrine administration in a titrated manner based on symptoms severity, and on volume expansion.
8 citations
TL;DR: This work presents a meta-anatomy of the central nervous system in the context of anesthesia and shows clear trends in prognosis and in particular in the treatment of central nervous disease and its complications.
Abstract: D. Duda, W. Lorenz, W. Dick, I. Celik, A. Black, M. J. R. Healy and J. W. Black Clinic of Anaesthesiology, Johannes Gutenberg University, Langenbeckstr. 1, D-55131 Mainz, Germany, Fax +49 6131 175518, e-mail: duda@goofy.zdv.uni-mainz.de Institute of Theoretical Surgery, Philipps University, Baldingerstr., D-35033 Marburg, Germany Department of Anaesthesia, Bristol Royal Infirmary, Bristol BS2 8HW, UK Departments of Medical Statistics and Epidemiology, London School of Hygiene and Tropical Medicine, 23 Coleridge Court, Milton Road, Harpenden, Herts AL5 5LD, UK James Black Foundation, 68 Half Moon Lane, Dulwich, London SE24 9JE, UK
7 citations
Cites background or methods from "Incidence and clinical importance o..."
...Based on Koch-Dale criteria for causality, 5 new groups were obtained from 240 patients of the Mainz-Marburg trial [3] who originally had been randomly assigned to 4 treatment groups (placebo-Ringer, placebo-Haemaccel, H1 and H2-Ringer, H1 and H2-Haemaccel)....
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...Hence a new attempt was made to change the intuitive decision making (pattern recognition) [5] of clinicians in recognising this new type of anaphylactoid reaction: from the 240 patients of the controlled clinical trial [3] cases were selected by a second randomised study with nested sampling [6]....
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...In addition to the classical signs of anaphylactic skin reactions, bronchospasm and hypotension (paradigm 1), more clinical signs (alone or in combination) associated with increased plasma histamine levels including bradycardia, hypertension, arrhythmia, myocardial ischaemia seen on the ECG (paradigm 2) were proposed as indicants for diagnosing histamine-related cardiorespiratory disturbances in the perioperative period [3]....
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28 Apr 2017
7 citations
TL;DR: An unusual allergic reaction to Ketamine in a 2.5-year-old child with bilateral congenital inguinal hernia is reported to alert all practitioners to some of the rare but potentially fatal side effects of Ketamine.
Abstract: Ketamine, a phencyclidine derivative, is a very popular and commonly used parenteral anesthetic agent. It is a safe drug in unskilled hands and a drug of choice in high-risk patients. We report an unusual allergic reaction to Ketamine in a 2.5-year-old child with bilateral congenital inguinal hernia. This is to alert all practitioners to some of the rare but potentially fatal side effects of Ketamine. Anaphylactic reactions to Ketamine are a rare but potentially fatal occurrence. Management includes treatment of acute reactions and avoidance of future reactions. There is no known antidote or reversal agent to Ketamine. So, once it is administered, one must be ready for it to complete full duration of its action. Facilities for resuscitation must be available any time an anesthetic is being administered, no matter how short or minor the surgery is.
7 citations
Cites background from "Incidence and clinical importance o..."
...H1 and H2 antihistamines can be effective in reducing histamine-related manifestations.[17] In the medical history of a patient, there must be a careful inquiry about possible predisposing factors, including known allergy or intolerance to drugs....
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TL;DR: Variations in plasma histamine concentrations produced during the course of cardiac surgery involving cardiopulmonary bypass are examined, the relationship between these variations and intra‐operative events is examined and the source of histamine is attempted.
Abstract: Histamine, an inflammatory mediator in its own right, may also be a marker for a more widespread systemic inflammatory process. In this study we have examined variations in plasma histamine concentrations produced during the course of cardiac surgery involving cardiopulmonary bypass, the relationship between these variations and intra-operative events. By assays of serum tryptase and CD-63 expression we have also attempted to identify the source of histamine. Histamine concentrations that were significantly raised from baseline level were demonstrated. These were elevated from the time of aortic cross-clamping and continued to be raised for 24 h postoperatively (p < 0.00625). This was associated with an increase in CD-63 expression (p < 0.025) (but not an increase in tryptase concentration) following aortic cross-clamping and protamine administration, suggesting that basophils are the source of histamine. 41% of patients had arrhythmias in the post bypass period. The rise in histamine levels was not related to the incidence of cardiac arrhythmias.
6 citations
References
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Journal Article•
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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