Kimura K, Adachi M, Kubo K
Department of Dental Anesthesiology, Faculty of Dentistry, Kyushu University, Fukuoka, Japan.
Inflamm Res. 1999 Nov;48(11):582-7. doi: 10.1007/s000110050507.
A prospective randomized controlled study was performed for patients with a history of allergy to evaluate the effect of the induction of anesthesia with propofol against histamine release, skin reactions, hemodynamic changes and other clinical symptoms, while also comparing these parameters during the induction of anesthesia with midazolam-ketamine for patients with a history of allergy.
We examined 40 patients undergoing oral surgery, who had a history of allergy and/or the percentage of eosinophils in the leukocytes was more than 3%.
Forty patients were randomly allocated into two groups and thus received either midazolam-ketamine (M-K group, n = 20) or fentanyl-propofol (propofol group, n = 20) for the induction of anesthesia. Venous blood samples (4 ml each) were obtained before induction as a control and at 0.5, 1, 3, 5 minutes after the administration of each induction agent, and then furthermore at 0.5, 1, 3, 5 minutes after tracheal intubation in order to measure the plasma histamine level by using the HPLC post-label system. In addition, the blood pressure and heart rate were also simultaneously recorded. Skin reactions were also evaluated by two anesthesiologists.
The incidence of 50% histamine release during the induction of anesthesia with propofol occurred in 15% of the patients with a history of allergy. Sixteen patients out of 20 (80%) showed a decrease in the systolic blood pressure after the administration of propofol without any evidence of histamine release. The incidence of 50% histamine release, skin reactions and an increase in the heart rate between the two groups were not statistically significant after the administration of each anesthetic agent. Moreover, some patients also demonstrated histamine release after tracheal intubation. Hemodynamic changes after tracheal intubation showed a similar tendency in both groups. No significant difference was observed regarding the incidence of histamine release, skin reactions and hemodynamic changes between both groups after tracheal intubation.
Propofol was found to show a similar incidence of histamine release during the induction of anesthesia using midazolam-ketamine, and thus was also found to be a useful induction agent against histamine release for patients with a history of allergy when hydroxizine was used as a premedication.
进行一项前瞻性随机对照研究，以评估丙泊酚用于有过敏史患者麻醉诱导时对组胺释放、皮肤反应、血流动力学变化及其他临床症状的影响，同时比较丙泊酚与咪达唑仑 - 氯胺酮用于有过敏史患者麻醉诱导时的这些参数。
我们检查了40例接受口腔手术且有过敏史和/或白细胞中嗜酸性粒细胞百分比超过3%的患者。
40例患者随机分为两组，分别接受咪达唑仑 - 氯胺酮（M - K组，n = 20）或芬太尼 - 丙泊酚（丙泊酚组，n = 20）进行麻醉诱导。在诱导前采集静脉血样本（各4 ml）作为对照，在给予每种诱导剂后0.5、1、3、5分钟采集样本，然后在气管插管后0.5、1、3、5分钟再次采集样本，以便使用高效液相色谱后标记系统测量血浆组胺水平。此外，还同时记录血压和心率。两名麻醉医生也对皮肤反应进行了评估。
丙泊酚麻醉诱导期间组胺释放达50%的发生率在有过敏史患者中为15%。20例患者中有16例（80%）在给予丙泊酚后收缩压下降，且无组胺释放迹象。给予每种麻醉剂后，两组之间组胺释放达50%、皮肤反应及心率增加的发生率无统计学差异。此外，一些患者在气管插管后也出现组胺释放。气管插管后的血流动力学变化在两组中显示出相似趋势。气管插管后两组之间在组胺释放、皮肤反应及血流动力学变化的发生率方面未观察到显著差异。
发现丙泊酚在使用咪达唑仑 - 氯胺酮进行麻醉诱导期间组胺释放发生率相似，因此当使用羟嗪作为术前用药时，丙泊酚也是有过敏史患者预防组胺释放的有用诱导剂。
