Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia

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urn:nbn:de:bvb:355-epub-217521 Copy

Lorenz, Wilfried ; Duda, D. ; Dick, W. ; Sitter, H. ; Doenicke, A. ; Black, A. ; Weber, Doris ; Menke, H. ; Stinner, B. ; Junginger, T. ; Trial Group, Mainz/Marburg

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Date of publication of this fulltext: 16 Aug 2011 12:01

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Item type:	Article
Journal or Publication Title:	Lancet (London)
Publisher:	Elsevier
Volume:	343
Number of Issue or Book Chapter:	8903
Page Range:	pp. 933-940
Date:	1994
Institutions:	Medicine > Zentren des Universitätsklinikums Regensburg > Tumorzentrum e.V.
Identification Number:	Value Type 7519707 PubMed ID
Classification:	Notation Type Adolescent MESH Adult MESH Aged MESH Aged, 80 and over MESH Anesthesia, General MESH Cimetidine/therapeutic use MESH Dimethindene/therapeutic use MESH Double-Blind Method MESH Female MESH Hemodynamics/drug effects MESH Histamine/blood MESH Histamine Release/drug effects MESH Humans MESH Intraoperative Complications/prevention & control MESH Male MESH Middle Aged MESH Polygeline/therapeutic use MESH
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Unknown
Item ID:	21752

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Abstract

Although histamine release is recognised as a common event during anaesthesia and surgery, few clinicians judge the resultant cardiorespiratory disturbances serious enough to warrant prophylaxis with antihistamines. We have assessed the incidence and importance of histamine release in a randomised 2 x 2 factorial study. 240 patients representing a routine throughput of major general surgery were ...

Abstract

Although histamine release is recognised as a common event during anaesthesia and surgery, few clinicians judge the resultant cardiorespiratory disturbances serious enough to warrant prophylaxis with antihistamines. We have assessed the incidence and importance of histamine release in a randomised 2 x 2 factorial study. 240 patients representing a routine throughput of major general surgery were studied during a standardised induction of anaesthesia and preoperative loading of the circulation with either Ringer solution or Haemaccel-35, with or without antihistamine prophylaxis with dimetindene (H1) plus cimetidine (H2). Cardiorespiratory disturbances were graded as detectable, clinically relevant, or life-threatening from observers' records of the anaesthesia and the actions taken by the anaesthetists. Disturbances that were accompanied by significant rises in plasma histamine were further designated histamine-related, and those that were not were designated histamine-unrelated. Anaesthetists, observers, and designators were blinded to whether or not the patients had received antihistamines and to which solution was used for circulatory volume loading. Clinically relevant or life-threatening histamine-related disturbances occurred in 8% of the patients who after induction of anaesthesia received Ringer without antihistamines, in 26% of those who received Haemaccel without antihistamines, and in 2% or less of those who received antihistamines (p < or = 0.0001). There were 4 life-threatening histamine-related disturbances, all in patients who received Haemaccel without antihistamines (p < 0.01). Histamine-unrelated disturbances occurred in 16% overall, with no obvious effect of Haemaccel or antihistamines. 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. Their likelihood and severity were increased in patients with tumours. The results of the trial make a case for routine prophylaxis with antihistamines as part of anaesthetic management.

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