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Histamine release by four narcotics: a double-blind study in humans.

J W Flacke, W E Flacke, B C Bloor

Anesthesia and Analgesia

|August 1, 1987

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Meperidine and morphine can cause histamine release and hemodynamic changes during anesthesia induction. Fentanyl and sufentanil did not show these effects, indicating safer alternatives for patients sensitive to histamine release.

Area of Science:

Anesthesiology
Pharmacology
Immunology

Background:

Opioid analgesics are commonly used for anesthesia induction.
Some opioids can trigger histamine release, leading to adverse hemodynamic effects.
Understanding these risks is crucial for patient safety during surgery.

Purpose of the Study:

To investigate histamine release and associated hemodynamic changes with four narcotics: meperidine, morphine, fentanyl, and sufentanil.
To compare the incidence and severity of histamine release among these opioids.
To identify patient factors associated with histamine release.

Main Methods:

A double-blind study involving 60 adult patients undergoing general surgery.
Incremental equipotent doses of meperidine, morphine, fentanyl, or sufentanil were administered intravenously for anesthesia induction.

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Arterial blood samples were analyzed for plasma histamine and epinephrine levels at specific time points post-administration.

Main Results:

Meperidine caused histamine release and hemodynamic changes in 31% of patients, with elevated plasma histamine and epinephrine.
One patient receiving morphine showed signs of histamine release and hemodynamic compromise.
Fentanyl and sufentanil did not induce histamine release or adverse hemodynamic effects in any patients.
Histamine release was significantly correlated with changes in heart rate, blood pressure, and epinephrine levels.
All patients exhibiting histamine release were young women (18-35 years).

Conclusions:

Meperidine poses a higher risk of histamine release and subsequent hemodynamic compromise compared to morphine, fentanyl, and sufentanil.
Fentanyl and sufentanil appear to be safer choices regarding histamine release during anesthesia induction.
Young women may be more susceptible to opioid-induced histamine release.