Perioperative nonspecific histamine release : a new classification by aetiological mechanisms and evaluation of their clinical relevance

Abstract

RI~SUM#: Les auteurs ont r6alis6 quatre 6tudes prospectives dans le but d'6tudier les diff6rents facteurs responsables de la lib6ration d'histamine dans la p6riode p6dop6ratoire. Les r6actions allergiques vraies et les r6actions pseudo-allergiques ne sont pas seules en cause. De nombreux autres m6canismes d'histaminolib6ration sont sugg6r6s : m6canismes neuroendocriniens, lib6ration cons6cutive ,~ des stimuli nociceptifs, facteurs cytotoxiques cons6cutifs au traumatisme tissulaire de l'acte chirurgical et lib6ration induite par les cytokines. Ces mdcanismes ont 6t6 mis en 6vidence darts deux 6tudes prospectives 6tudiant, l'une des patients lors d'une gastroscopie r6alis6e sans pr6m6dication et l'autre, des patients b6n6ficiant d'une chol6cystectomie perccelioscopique. Darts une autre 6tude, une histaminolib6ration par mdcanisme pseudoallergique a 6t6 not6e imm6diatement apr~s l'induction anesth6sique chez un hombre important de patients op6r6s pour divers acres de chirurgie g6n6rale. Dans ces deux cas, I'histaminolib6ration est ind6sirable car elle est ~a l'origine de sympt6mes de gravit6 variable. Les signes cliniques sont surtout cardiovasculaires et respiratoires alors que les signes cutan6s sont souvent absents. Les auteurs consid~-rent que dans la pdriode p6riop6ratoire la lib6ration d'histamine est ind6sirable dans certains cas mais darts d'autres elle n'a pas de cons6quences n6fastes, pouvant m6me 6tre b6n6fique. Une r66valuation des signes cliniques d'histaminolib6ration est n6cessaire puisque les 6tudes ont montr6 que des concentrations plasmatiques de 12 ng. ml -~ d'histamine souvent ne s'accompagnaient d'aucun signe cutan6. Ainsi une histaminolib6ration non sp6cifique n'est, le plus souvent, pas reconnue comme cause d'une hypotension art6rielle p6riop6ratoire en raison du manque de sp6cificit6 de ce sympt6me. Des 6tudes ult6rieures doivent pr6ciser le r61e des m6dicaments antihistaminiques (anti-H1 et anti-H2, doses, choix des patients, moment de Fadministration) darts la pr6vention de l'histaminolib6ration p6riop6ratoire. CLASSIFICATION OF PERIOPERATIVE HISTAMINE RELEASEIn the last conference on prevention of perianaesthetic anaphylactoid reactions, Nancy, 1984 [52], a whole series of mechanisms for nonspecific histamine release was not mentioned at all [62]. Surgical trauma was included, but only one reference could be given at this time [93] and did not challenge the general opinion over 50 years that ,~ histamine does not play an important role in major injury or traumatic shock, [1, 311In this conference [54], however, a considerable increase of knowledge has to b~ reported which creates new hypotheses on functions of histamine in clinical epidemiology ( fig. 1). A new classification has to be found which does not only alter aetiology, but also pathogenesis and disease manifestations, especially in the perioperative and postoperativ e period.

Early and late histamine release induced by albumin, hetastarch and polygeline: some unexpected findings

“…Study 2: Histamine release during medical intervention in patients on a normal ward, neuroendocrine histamine release [25] Over a period of 60 min, the plasma histamine concentrations decreased from 0.26 ± 0.03 ng/ml (mean ± SEM) at baseline (insertion of catheter) to 0.12 ± 0.03 ng/ml (mean ± SEM) after 60 min (Fig. 4).…”

“…In order to also investigate the neuro-endocrine (central effects of stress) [4,25] and the neuro-inflammatory stimuli, peripheral stimulation of pain fibers, effects on plasma histamine levels due to specific events like painful interventions (e. g. insertion of catheter or pain during blood sampling etc.) [25] and technique related interaction (e. g. blood sampling) a supplementary prospective case series clinical study was performed with application of Ringer solution as control.…”

“…[25] and technique related interaction (e. g. blood sampling) a supplementary prospective case series clinical study was performed with application of Ringer solution as control.…”

“…In order to investigate the influence of neuroendocrine induced histamine release [4,25] due to specific events during the course of the experiment e. g. painful insertion of a catheter [25], nine further volunteers were enrolled in a separate prospective case series study. The study was conducted under standardized conditions to investigate the course of plasma histamine under physiological conditions and with Ringer's solution (500 ml/h) as volume substitution.…”

Antibiotic prophylaxis influences cardiovascular stability in complicated surgery

“…The following investigation has focused on the feasibility of using a model for simulating a complicated major surgical procedure, including blood loss and management of complications. The study examines whether two different antibiotic prophylactic regimens have different effects on intraoperative cardiovascular stability and histamine release, as surrogate parameter for mediator activation, leading to a non optimum outcome after surgery [23].…”