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

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.
• 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.