Are hypotension and rash after atracurium really caused by histamine release?
نویسندگان
چکیده
A prospective, randomized, double-blind study was performed in 40 patients (ASA class I-III) treated with atracurium to ascertain whether histamine release caused hemodynamic or cutaneous changes. The treated group of 20 patients was premedicated with the H1 antagonist dimetindene (0.2 mg/kg) and the H2 antagonist ranitidine (1.25 mg/kg); the control group of 20 patients received saline. Six minutes after the induction of anesthesia with thiopental/fentanyl, patients received atracurium 0.5 mg/kg over 5 s. Plasma histamine levels were measured fluorometrically 5 min after administration of thiopental/fentanyl and 2 and 5 min after atracurium. Arterial blood pressure and heart rate were recorded every 2 min. Histamine levels (0.24 ng/mL) did not change significantly after thiopental/fentanyl. In the control group, 2 min after injection of atracurium, plasma histamine levels were 0.76 +/- 0.76 ng/mL, and in the antihistamine-treated group, 0.39 +/- 0.24 ng/mL (P < 0.05 control versus treated), suggesting that pretreatment with antihistamines may attenuate atracurium-induced histamine release. Systolic and diastolic blood pressure decreased significantly in both groups after thiopental (P < 0.05), but did not decrease further after the administration of atracurium. There were cutaneous manifestations in 7 of 20 patients in the control group and in none of the 20 patients treated with H1 and H2 antagonists (P < 0.0005). We conclude that atracurium caused modest histamine release in our patients but that the decrease in arterial blood pressure may have been due, in part, to thiopental. Cutaneous manifestations of histamine release did not correlate with hemodynamic events or with plasma histamine levels, but were prevented with antihistamine pretreatment.
منابع مشابه
The Incidence of hypotension with continuous infusion atracurium compared to cisatracurium in the Intensive Care Unit
BACKGROUND A drug shortage of cisatracurium led to use of atracurium as an alternative neuromuscular blocker (NMB). Cisatracurium may be preferred due to less histamine release and potentially less hypotension. The study purpose is to compare the incidence of hypotension with continuous infusion atracurium to continuous infusion cisatracurium in ICU patients. MATERIALS AND METHODS This retros...
متن کاملThe pharmacology of atracurium: a new competitive neuromuscular blocking agent.
Atracurium besylate, 2,2'-(3,11-dioxo-4,10-dioxatridecylene)-bis-[6,7-dimethoxy-1-(3,4-dimethoxy-benzyl)-2-methyl-1,2,3,4-tetrahydroisoquinolinium] dibenzenesulphonate, is one of a new series of competitive neuromuscular blocking agents. An i.v. dose of 0.25 mg kg-1 produced complete paralysis in anaesthetized cats, dogs and rhesus monkeys; paralysis was of medium duration and was readily antag...
متن کاملHistamine release during the administration of atracurium or vecuronium in children.
The histamine releasing potential of equivalent bolus doses of atracurium 0.6 mg kg-1 or vecuronium 0.12 mg kg-1 was evaluated in 20 children anaesthetized with halothane. Blood samples were obtained before, and at 2 and 5 min after the administration of the neuromuscular blocker. The twitch response to 0.15 Hz was also evaluated. None of the 10 patients receiving vecuronium had a significant i...
متن کاملHistamine release by neuromuscular blocking agents.
Histamine release by neuromuscular blocking agents Sir,—The design of the study by Naguib and colleagues [1] on the histamine releasing potencies of various neuromuscular blocking drugs resulted in cardiovascular changes which were profound, adverse and predictable. For example, the data sheet for mivacurium suggests administration over 5–15 s. The authors chose 5 s, despite quoting references ...
متن کاملEffect of atracurium, vecuronium, pancuronium and tubocurarine on renal sympathetic nerve activity in baroreceptor denervated dogs.
The mechanism of arterial hypotension induced by non-depolarizing neuromuscular blocking agents may be multifactorial and differ between drugs. The purpose of this study was to evaluate the effect of high-dose atracurium and equivalent doses of other non-depolarizing neuromuscular blocking agents on haemodynamic state and sympathetic nervous activity. In studies on 24 mongrel dogs anaesthetized...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Anesthesia and analgesia
دوره 78 5 شماره
صفحات -
تاریخ انتشار 1994