Changes in histamine blood levels followingd-tubocurarine administration

Anaphylaxis due to succinylcholine. Immunoallergological study of thirteen cases

The antigen non-specific release of histamine by synthetic neuromuscular blocking agents is well known, though our review of thirty-two cases reported in the literature of anaphylactoid reactions to succinylcholine, shows that there is insufficient evidence to determine whether the signs are due to anaphylactic or to anaphylactoid reactions. We have examined thirteen cases in whom evidence of anaphylactic sensitization was examined by direct skin tests (in eleven cases) Prausnitz--Küstner tests (in five), rabbit basophil degranulation, Shelley test (in twelve) and human basophil degranulation (in seven). These tests were done on two to four occasions, and the optimal period for the first test ascertained to be 6 to 12 weeks after the episode. All eleven patients examined by direct skin tests showed evidence of anaphylactic sensitivity, and in three of five cases the sensitivity could be transferred by the Prausnitz--Küstner procedure. In one of these P--K tests there was evidence of both IgE and of IgG S-TS antibodies (heat-stable antibody conferring sensitivity for 2 hr). Particular susceptibilities to adverse reactions of this drug appear to be prior drug allergy (in 50% of cases), several previous anaesthetics, and atopy.

Anaphylactoid response to intravenous tubocurarine

A case of severe anaphylactoid reaction to tubocurarine in a 42-year-old female is described. This is particularly notable as there was no history of past allergies or of previous exposure to the drug.

Carcinoid syndrome: its relevance to the anaesthetist

This paper presents the pathology, pharmacophysiology and therapy of the carcinoid syndrome. Forty reports from the literature are reviewed and the anaesthetic management of the patients is discussed. The carcinoid syndrome is a rare multihumoral endocrine disease. Secretions may be stimulated by certain anaesthetic and surgical manoeuvres and produce undesirable, and occasionally fatal, cardiovascular and respiratory complications. A radical surgical approach to the disease is current. Anaesthetists may therefore be involved in the management of these patients more frequently than before. The implication of both serotonin and bradykinin in the pharmacophysiology of this disease allows a more rational approach to the treatment of complications occurring during anaesthesia. However, other, as yet undiscovered vasoactive substances, may be involved.

Severe histamine mediated reactions to intravenous drugs used in anaesthesia

Severe histamine mediated reactions to intravenous drugs used in anaesthesia may occur as a result of anaphylactic and anaphylactoid reactions. The incidence is rare, but appears to be increasing. The difficulties in diagnosing such reactions and in determining the drug responsible and how these difficulties have led to confusion in the literature are discussed. Six cases of severe histamine mediated reactions are presented and detailed analyses of the drugs in these and other reported reactions is made showing varied clinical patterns with different drugs. The prevention, treatment, and follow-up of severe histamine mediated reactions are considered.