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
TL;DR: To termine risk factors for an u n w a n t e d ou tcome, the use of a cer ta in mode l is necessary and the result o f the r isk analysis will be dependen t on the mode l chosen.
Abstract: His taminere la t ed ca rd io re sp i r a to ry d is turbances occur in rou t ine anaes thes ia wi th an incredib ly high incidence ( 8 2 6 % ) [1]. This f inding urgent ly d e m a n d e d a search for the r isk factors involved, no t only in an explora t ive way, bu t by a fo rmal ep idemiologica l s tudy [2]. However , to de termine risk factors for an u n w a n t e d ou tcome, the use of a cer ta in mode l is necessary and the result o f the r isk analysis will be dependen t on the mode l chosen. In general , a mode l is a represen ta t ion o f a slice o f the real i ty of the mode l builder . I t consists of logic re la t ionships descr ibed in a ma thema t i ca l way. Every mode l is targetor iented, hence different targets can p r o d u c e different models , even wi thin the same frame. This will be demons t r a t ed for r isk factors in the M a i n z M a r b u r g tr ial on per iopera t ive h is tamine release [1].
5 citations
Cites background or methods from "Incidence and clinical importance o..."
...His tamine- re la t ed ca rd io re sp i r a to ry d is turbances occur in rou t ine anaes thes ia wi th an incredib ly high incidence ( 8 - 2 6 % ) [1]....
[...]
...This will be demons t r a t ed for r isk factors in the M a i n z - M a r b u r g tr ial on per iopera t ive h is tamine release [1]....
[...]
...For the model building process, 240 patients in general surgery were selected from 4230 subjects in Mainz in 1989-1991 by a recruitment algorithm which provided representativeness [1]....
[...]
01 Jan 2006
4 citations
Additional excerpts
...[Lorenz et al. 1994]....
[...]
...Plasmahistamin (ng/ml) 2,4 (1,75-4,00) 25,55 (5,2-100,00) 24,75 (3,06-79,3) 18,10 (2,5-55,0) 13,5 (2,10-39,60) 7,00 (1,90-23,30) RR systolisch (mmHg) 180 (145-185) 110 (70-165) 95 (45-160) 125 (55-160) 90 (75-165) 120 (90-165) RR diastolisch (mmHg) 125 (100-130) 80 (50-110) 65 (25-110) 70 (30-120) 60 (40-125) 80 (55-120) Herzfrequenz (bpm) 182 (137-213) 228 (215-238) 232 (210-236) 217 (200-238) 213 (198-241) 213 (206-240)...
[...]
...RR systolisch (mmHg) 119 (95-160) 100 (80-130) 90 (55-120) 100 (40-130) 92,5 (40-125) 85 (75-120) RR diastolisch (mmHg) 57,5 (40-115) 60 (40-100) 50 (30-75) 57,5 (25-80) 50 (25-80) 47,5 (30-75)...
[...]
...0) 5,50 (3,30-95,40) 5,00 (2,80-52,20) 13,40 (4,10-52,40) 9,93 (3,40-77,36) 7,15 (5,30-50,03)...
[...]
TL;DR: The two independent raters were not able to detect systematic variations in the interviewing style that were contingent on treatment arm assignment, giving further credence to the results of the randomised trial showing greater patient-reported discomfort and inconvenience with the nasogastric tube than with the gastrostomy tube.
Abstract: Blind, randomised trials are conceived as the gold standard in clinical research, but this ideal, in its strict sense, can rarely be achieved in surgical settings. One way to strengthen the study design is to check for observer bias in the assessment and evaluation of surgical outcome. In a randomised, prospective trial comparing nasogastric versus gastrostomy tubes the primary endpoint was the subjective inconvenience induced by the tube system and was assessed in the context of a standardised face-to-face interview. These interviews were tape-recorded on a pocket memo. Two independent raters listened to these interviews and judged—on the basis of how the interviewer formulated the questions—which treatment arm they thought the patients were assigned to and how confident they were in their judgement. The overall proportion of correct judgements was 50.5% for rater 1 and 53.2% for rater 2. In other words, both judgement performances were not greater than chance. Nevertheless, the raters’ confidence in their judgements increased significantly (P<0.05) in the course of the rating procedure, whereas the actual proportion of correct judgements did not. There was no overlap between the two raters [kappa = 0.022, not significant (NS)] and between actual group assignment and both raters’ judgements (kappa = 0.012, NS and kappa = 0.110, NS). The two independent raters were not able to detect systematic variations in the interviewing style that were contingent on treatment arm assignment. This gives further credence to the results of the randomised trial showing greater patient-reported discomfort and inconvenience with the nasogastric tube than with the gastrostomy tube. The present report describes a feasible method to monitor subtle biases that may occur in trial settings. This helps to strengthen the design of randomised clinical trials in surgery.
4 citations
TL;DR: Intra‐abdominal surgery causes plasma extravasation which, in the rat, is prevented by combined histaminergic H1 and H2 blockade, which is evaluated to evaluate the relative importance of H1-H2 blockade in this situation.
Abstract: Intra-abdominal surgery causes plasma extravasation which, in the rat, is prevented by combined histaminergic H1 and H2 blockade. We evaluated the relative importance of H1 and H2 blockade in this situation. Cloralose-anaesthetized Wistar rats were subjected to a standardized abdominal trauma. Mean arterial pressure (MAP), heart rate (HR) and haematocrit (Hct) were monitored and plasma volume (PV) was determined before and 1 h after the trauma. Compared to non-traumatized rats (n = 8), the trauma decreased PV and increased Hct (n = 8). MAP decreased during the actual trauma, whereas HR remained stable throughout. In animals given cimetidine 25 mg kg-1 i.v. just prior to the trauma (n = 8), PV, Hct and MAP changed, as in the non-blocked rats. In contrast, pyrilamine, 10 mg kg-1, completely prevented the decrease in PV and the increase in Hct (n = 7), but not the decrease in MAP. The findings suggest that a histaminergic H1 mechanism is of importance for the plasma loss elicited by intra-abdominal trauma.
3 citations
01 Jan 2005
TL;DR: Köpeklerde mepyramine’in xylazine’e bağlı bulantı ve kusmanın önlenmesinde etkili olduğu, diğer parametrelerde istatistik ÷nemi bulunan bir değişikliğin olmadığı belirlendi.
Abstract: Özet: Bir α2 adrenoreseptör agonisti olan xylazine uygulamasına bağlı olarak köpeklerde bradikardi, hipotansiyon, hipopnea, bulantı ve kusma gibi yan etkiler görülebilmektedir. Bu çalışma xylazine hydrochloride’e bağlı oluşan bulantı ve kusmanın önlenmesinde bir H1 reseptör antagonisti olan mepyramine maleate’ın etkinliğinin araştırılması amacıyla yapıldı. Çalışmada 30 köpek kullanıldı ve köpekler 10’arlı 3 gruba ayrıldı. Çalışmada antihistaminik uygulamasının yapıldığı an 0. dakika kabul edilerek, birinci guruptakilere 1 mg/kg, ikinci gruptakilere 2 mg/kg dozda intramuskuler (i.m.) mepyramine ve üçüncü gruptakilere ise eşit miktarda i.m. serum fizyolojik enjeksiyonu yapıldı. Bütün köpeklere bu enjeksiyonlardan 20 dakika sonra 2,2 mg/kg dozda i.m. xylazine enjekte edildi. Xylazine enjeksiyonundan sonra birinci ve ikinci gruptakilerden birer köpek kusarken üçüncü gruptakilerden sekiz köpek kustu. Üçüncü gruptakilerden dokuzunda bulantı gözlenirken, birinci grupta 2 ve ikinci grupta 3 köpekte bulantı saptandı. Birinci ve ikinci gruplarda mepyramine uygulamasından sonraki 40., 60. ve 80. dakikalarda (xylazine uygulamasından sonraki 20., 40. ve 60. dakikalar) pulzasyon ve respirasyon önemli (P<0,001) oranda düşerken, beden ısılarındaki düşüşün istatistiksel önemi yoktu. Sonuç olarak, köpeklerde mepyramine’in xylazine’e bağlı bulantı ve kusmanın önlenmesinde etkili olduğu, diğer parametrelerde istatistik önemi bulunan bir değişikliğin olmadığı belirlendi. Anahtar Kelimeler: Köpek, xylazine, mepyramine maleate, kusma, antihistaminik.
3 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