[Processes of perioperative risk from the viewpoint of the anesthesiologist]

Nearly all of the pharmaceutical preparations that are used for anesthesia can release histamine. H1 and H2 receptor blockades are recommended for the following groups of patients at risk: 1) Patients who show hypersensitivity to i.v. administered medications and radiological contrast media. 2) Patients with risk factors in their case histories, e.g., atopy, previous cardiac and/or pulmonary damage, and an age of over 70 years. 3) Conditions with a pathological increase in the plasma histamine level. Such conditions include (a) polytrauma, chronic kidney insufficiency, patients under radium irradiation treatment; (b) the exploration phase during a surgical procedure, more frequent blood transfusions, extracorporeal circulation, and Palacos implantation. 4) Chymopapain for chemonucleolysis.

A pharmacologic study on the histamine releasing effect of atracurium and other muscle relaxants in rat isolated ileum

In this study, the effects of histamine, antihistamines (terfenadine and mepyramine), 5-hydroxytryptamine, and muscle relaxants, atracurium, vecuronium and gallamine, on the tone and contractility of rat ileum were studied and compared in vitro. The aim of the present investigation was to measure, pharmacologically, the histamine releasing effect of muscle relaxants, e.g atracurium, vecuronium and gallamine, by comparing their contractile response in the absence and presence of antihistamines and comparing their mechanical responses with those produced by histamine and 5-hydroxytryptamine (5-HT). The results showed that the antihistamines, triludan(terfenadine) and mepyramine produced opposite effects in rat ileum. Terfenadine (0.1-20 microM) produced concentration-dependent contractions in the rat ileum, whereas mepyramine (0.1-10 microM) relaxed the muscle, e.g. by 1.2 g tension. Atracurium (0.5-500 microM), vecuronium (0.2-200 microM), and gallamine (0.1-7.0 microM) produced marked contractions (1.5-4.0 g tension) in rat ileum, and these contractions were markedly reduced by mepyramine (1.3 microM) or terfenadine (5 microM), implicating histamine release in the generation of these contractions. However, there was some residual contraction which was not blocked by mepyramine, but by 5-HT antagonist, methysergide (1 microM), indicating that a mechanism other than histamine release may be responsible for the residual contraction, i.e. release of other mediators such as 5-HT, prostaglandins, or calcium. 5-HT (0.5-500 microM) and histamine (0.5-500 microM) produced contractions in the rat ileum, but 5-HT was more effective than histamine in producing these contractions. Similarly, gall amine was more effective than atracurium and vecuronium in contracting the rat ileum.(ABSTRACT TRUNCATED AT 250 WORDS)

Basophil histamine release. A study in allergy to suxamethonium

A patient who suffered a severe hypotensive episode after induction of anaesthesia, was subsequently found to show positive skin-test responses to suxamethonium. Investigation revealed that suxamethonium induced basophils from the patient to release histamine to an extent comparable to that found after exposure to anit-IgE. Basophils from control subjects showed no such response. Basophil histamine release may offer a useful approach to the investigation of adverse drug reactions.

Forum. The use of atracurium besylate for laparoscopy

An anaesthetic technique is described for laparoscopy using an intravenous induction, atracurium 0.2 mg/kg for muscle relaxation and intermittent positive pressure ventilation of the lungs with nitrous oxide and oxygen. It was found to be a suitable and simple technique. Recovery of spontaneous ventilation was achieved without the use of reversal agents in all 40 patients. A 15% incidence of cutaneous histaminoid reactions was noted. This is no higher than reported in other studies of atracurium, and further clinical trials are awaited.

Detection of serum IgE antibodies that react with alcuronium and tubocurarine after life-threatening reactions to muscle-relaxant drugs

Although anaphylactoid reactions to muscle-relaxant drugs are now well recognised, there has been no general agreement on the mechanism(s) underlying the responses. By covalently coupling alcuronium and tubocurarine to a solid phase carrier and using the resultant complexes in radioimmunoassay experiments with patients' sera and 125I-anti-human IgE, we have found high levels of drug-specific IgE antibodies in the sera of some subjects who reacted to these muscle relaxants. These results provide important supporting evidence that, in some patients at least, life-threatening anaphylactoid reactions to muscle-relaxant drugs are mediated by drug-specific IgE antibodies.