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Narcotic-induced histamine release: a comparison of morphine, oxymorphone, and fentanyl infusions
M A Warner1, M P Hosking, J R Gray
1Department of Anesthesiology, Mayo Medical School, Rochester, MN 55905.
Abstract:
This study, using an improved histamine assay, repeated previous studies that demonstrated large doses of morphine for induction of anesthesia in patients undergoing coronary artery bypass grafting were associated with histamine release. Thirty randomized patients received infusions of either morphine, 1 mg/kg, oxymorphone, 0.2 mg/kg, or fentanyl, 50 micrograms/kg, over a 10-minute period for induction of anesthesia prior to surgery. There were no significant changes in plasma histamine levels in individual patients or among drug groups. The discrepancy between the present histamine results and those previously reported using similar protocols is due, in part, to variations in plasma histamine measurements that can occur using the less reproducible, older assays for histamine. During routine inductions, large doses of morphine, oxymorphone, or fentanyl administered by infusion do not appear to stimulate release of clinically significant plasma levels of histamine.
Insights
Large doses of morphine, oxymorphone, or fentanyl for anesthesia induction do not significantly increase histamine release. Improved assays show no significant changes in plasma histamine levels during routine inductions.
Area of Science:
- Anesthesiology
- Pharmacology
- Cardiovascular Surgery
Background:
- Previous studies suggested large-dose morphine for anesthesia induction during coronary artery bypass grafting (CABG) causes histamine release.
- Histamine release during anesthesia induction can lead to adverse hemodynamic effects.
Purpose of the Study:
- To investigate histamine release associated with large doses of morphine, oxymorphone, or fentanyl for anesthesia induction in CABG patients.
- To compare histamine release among these three opioid analgesics using an improved assay.
Main Methods:
- Thirty randomized patients undergoing CABG received infusions of morphine (1 mg/kg), oxymorphone (0.2 mg/kg), or fentanyl (50 mcg/kg) over 10 minutes for anesthesia induction.
- Plasma histamine levels were measured using an improved assay before and after drug administration.
Main Results:
- No significant changes in plasma histamine levels were observed in individual patients or across the drug groups.
- The findings contrast with some previous studies, potentially due to variations in histamine assay reproducibility.
Conclusions:
- Routine induction anesthesia with large doses of morphine, oxymorphone, or fentanyl via infusion does not appear to cause clinically significant histamine release.
- The improved histamine assay provides more reliable measurements, clarifying previous discrepancies.