Plasma histamine levels in patients in the course of several standard operations: Influence of anaesthesia, surgical trauma and blood transfusion

Abstract

Summary.A prospective controlled clinical trial was conducted on changes in plasma histamine and catecholamine levels during 5 standard operations. This communication, as the first part of the trial, deals only with the feasibility of such a trial and the changes in plasma histamine levels.Elevated histamine concentrations corresponding to histamine-release responses of > 1 ng/ml occurred in 8 of 25 operations. In an explorative analysis these reponses were associated with distinct phases of anaesthesia or the surgical procedure.Blood transfusion carried the risk of infusion of "free histamine" into the patient -especially when administerea under pressure.Since during operations "free histamine" enters the circulation with a rather high incidence and may cause harmful effects, premedication with Hl-+Hz-receptor antagonists seems worth consideration.Key words: Standard operations anaesthesia -blood transfusion -plasma histamine Plasmahistaminspiegel bei Patienten im Verlauf von versehiedenen Standardoperationen: Einflufl yon An/isthesie, chirurgisehem Trauma und BluttransfusionZusammenfassung. Eine prospektive kontrollierte klinische Studie wurde fiber Ver/inderungen des Plasmahistamin-und Katecholaminspiegels bei 5 Standardoperationen durchgeffihrt. Diese Mitteilung, als erster Teil der Studie, zeigt nur die M6gtichkeiten auf, eine solche Studie durchzuf/ihren und Ver/inderungen des Plasmahistaminspiegels nachzuweisen.Erh6hte Plasmahistaminkonzentrationen, die einer Histaminfreisetzungsreaktion yon > 1 ng/ml entsprechen, kamen bei 8 yon 25 Operationen vor. In einer explorativen statistischen Analyse wurden diese Reaktionen mit bestimmten Phasen der An/isthesie oder des chirurgischen Eingriffs in Verbindung gebracht.Bluttransfusionen tragen das Risiko in sich, ,,freies Histamin" in den Patienten zu infundieren -zumal bei Filterpassage, wenn es unter erhthtem Druck angewandt wird.

Histamine in Anaesthesia and Surgery: Causality Analysis

“…This work was systematically extended over the next 15 years (KUSCHE et al 1977a,b;THERMANN et al 1978;KUSCHE et al 1978KUSCHE et al , 1979ROHER et al 1982;Lorenz et al 1984b;DIETZ et al 1984;KUSCHE et al 1985;DOENICKE et al 1985;LORENZ and DOENICKE 1985a;STAHLKNECHT et al 1985;DIETZ et al 1988;LINDLAR et al 1989). Recently this approach was taken up very successfully by the Hammersmith group, mainly in cardiac and transplantation surgery (MARATH et al 1987(MARATH et al , 1988aHANSEN et al 1988;STEGER et al 1989;TIMONEY et al 1989).…”

“…Another approach was that of collecting blood at stages during standard procedures which were believed to carry a greater risk of increasing plasma histamine levels, such as manual explorations in body cavities, e.g. after opening the chest or the abdomen, detachments of adhesions with more or less fresh connective tissue, dissections and resections creating more or less tissue injury and temporal or permanent tissue ischaemia and reperfusion (LORENZ et al 1973a,b;THERMANN et al 1978;ROHER et al 1982). Figure 9, showing an example of this type of study (Fig.…”

“…Drugs administered just before skin incision such as antibiotics (DEWDNEY 1980;SALO 1989) or during surgical procedures such as blood, erythrocyte and platelet concentrates (ROHER et al 1982;FREWIN et al 1984;HARKE 1985;MUYLLE et al 1988), heparin in cardiac surgery (ADT et al 1987(ADT et al , 1988(ADT et al , 1989 and protamine for its neutralization (HORROW 1985a,b;MOREL et al 1987), contrast media as described previously and chymopapain for chemonucleolysis of an incarcerated intervertebral disc have all been shown to release histamine in patients during the operations. Typical examples include the administration of erythrocyte concentrates through filters which bind cellular aggregates (Fig.…”

“…11. Histamine concentrations in the "plasma supernatant" of erythrocyte concentrates used for blood transfusion in the study of ROHER et al (1982). Note the high levels at the end of transfusion applying considerable pressure to push the residual blood through the stuffed filters …”

33. Prozesse des perioperativen Risikos aus der Sicht des Anaesthesisten

“…Mit der Transfusion fiber einen Filter konnte bei Patienten ein deutlich h6herer Histaminspiegel gemessen werden als in der Blutkonserve [14,24]. Bei Massivtransfusionen, insbesondere mit ~ilterem Konservenblut, ist eine Steigerung des Risikos vorhanden, da die Gefahr einer vermehrten Histaminwirkung besteht.…”