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33. Prozesse des perioperativen Risikos aus der Sicht des Anaesthesisten

Perioperative risks from the view of the anesthesiologist

  • B. Wissenschaftliches Programm
  • I. Hauptthemen E. Perioperatives Risiko — Kontroversen zur Pathogenese
  • Published:
Langenbecks Archiv für Chirurgie Aims and scope Submit manuscript

Summary

Nearly all of the pharmaceutical preparations that are used for anesthesia can release histamine. Hl and HZ receptor blockades are recommended for the following groups of patients at risk: 1)Patients who show hypersensitivity to i.v. administered medications and radiological contrast media. 2) Patients with risk factors in their case histories, e.g., atopy, previous cardiac and/or pulmonary damage, and an age of over 70 years. 3) Conditions with a pathological increase in the plasma histamine level. Such conditions include (a) polytrauma, chronic kidney insufficiency, patients under radium irradiation treatment; (b) the exploration phase during a surgical procedure, more frequent blood transfusions, extracorporeal circulation, and Palacos implantation. 4) Chymopapain for chemonucleolysis.

Zusammenfassung

Nahezu alle Pharmaka, die zur Anaesthesie benutzt werden, können Histamin freisetzen. Für folgende Risikopatienten ist H1- und H2 Receptorblockade zu empfehlen: 1. Patienten, die eine Überempfindlichkeit gegen i. v. applizierte Medikamente und Röntgenkontrastmittel aufweisen. 2. Patienten mit Risikofaktoren in der Anamnese z. B. Atopie, kardiale und/oder pulmonale Vorschädigungen und älter als 70 Jahre. 3. Situationen mit pathologisch erhöhtem Plasmahistamin. Hierzu gehören: a) Polytrauma, chronische Niereninsuffizienz, Patienten unter Radiumbestrahlung. b) Explorationsphase während des chirurgischen Eingriffes, vermehrte Bluttransfusionen, extracorporaler Kreislauf, Implantation von Palacos. 4. Chymopapain zur Chemonukleolyse.

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Literatur

  1. Dietz W, Lennartz H, Köpf J, Schmal A, Kaiser U, Lorenz W (1987) Lebensbedrohliche anaphylaktoide Reaktionen im perioperativen Zeitraum: Blockade durch Histamin H,- + H2 Antagonisten oder Methylprednisolon? (im Druck)

  2. Doenicke A, Ennis M, Lorenz W (1985) Histamin release in anesthesia and surgery: a systematic approach to risk in the perioperative period. In: Sage DJ (ed) Anaphylactoid reactions in anesthesia. Little Brown, Boston (Int Anesthesiology Clinics 23:41)

    Google Scholar 

  3. Doenicke A, Lorenz W (1970) Histaminfreisetzung und anaphylaktische Reaktionen bei i. v. Narkosen. Biochemische und klinische Aspekte. Anaesthesist 19:413

    Google Scholar 

  4. Doenicke A, Lorenz W (1982) Histamine release in anaesthesia and surgery. Premedication with H1- and H2-receptor antagonists: indications, benefits and possible problems. Klin Wochenschr 60:1039

    Google Scholar 

  5. Doenicke A, Lorenz W, Beigl R, Bezecny H, Uhlig G, Praetorius B, Mann G (1973) Histamin release after i. v. application of shortacting hypnotics. A comparison of etomidate, althesin CT 134 and propanidid. Br J Anaesth 45:1097

    Google Scholar 

  6. Doenicke A, Lorenz W, Dittmann J, Hug P (1980) Histaminfreisetzung nach Diazepam/Lormetazepam in Kombination mit Etomidat. In: Doenicke A, Ott H (Hrsg) Lormetazepam. Springer, Berlin Heidelberg New York (Anaesthesisl Wiederbeleb 133:11.l)

    Google Scholar 

  7. Doenicke A, Lorenz W, Hug P (1978) Histamine et etomidate. Ann Anesth Fr 19:207

    Google Scholar 

  8. Doenicke A, Lorenz W, Suttmann H, Duka Th, Bretz Ch, Schmal A (1985) Histaminfreisetzung und Katecholamine. In: Doenicke A, Lorenz W (Hrsg) Histamin und Histamin-RezeptorAntagonisten. Springer, Berlin Heidelberg New York Tokyo (Sertürner Workshop 5:25)

    Google Scholar 

  9. Dukor P, Kallos P, Schlumberger HD, West GB (1980) Introduction. In: PAR. Pseudo-allergic reactions. Involvement of drugs and chemicals. Karger, Basel, Vol l:9

    Google Scholar 

  10. Gell PGH, Coombs RRA (1975) Clinical aspects of immunology. Blackwell, Oxford, p 1754

    Google Scholar 

  11. Harke H (1985) Der Histamingehalt in Blutkonserven. In: Doenicke A, Lorenz W (Hrsg) Histamin und Histamin-Rezeptor-Antagonisten. Springer, Berlin Heidelberg New York Tokyo (Sertürner Workshop 5:39)

    Google Scholar 

  12. Lorenz W, Doenicke A (1978) Histamine release in clinical conditions. Mt Sinai J Med 45:357

    Google Scholar 

  13. Lorenz W, Doenicke A (1978) Anaphylactoid reactions and histamine release by intravenous drugs used in surgery and anaesthesia. In: Watkins J, Ward AM (eds) Adverse response to intravenous drugs. Academic Press, London, p 83

    Google Scholar 

  14. Lorenz W, Doenicke A (1985) H2- and H2 blockade: a prophylactic principle in anaesthesia and surgery against histamine-release responses of any degree of severity. N Engl Reg Allergy Proc part 16:37, part 11 6:174

  15. Lorenz W, Doenicke A (1986) Histaminfreisetzung als perioperative Risiko-Prophylaxemass-nahmen. Editorial. Dtsch Ärztebl 83:952

    Google Scholar 

  16. Lorenz W, Doenicke A, Dittmann I, Hug P, Schwarz B (1977) Anaphylaktoide Reaktionen nach Applikation von Blutersatzmitteln beim Menschen: Verhinderung dieser Nebenwirkung von Haemaccel durch Prämedikation mit H1- und H2 Rezeptorantagonisten. Anaesthesist 26:644

    Google Scholar 

  17. Lorenz W, Doenicke A, Schöning B, Mamorski J, Weber D, Hinterlang E, Schwarz B, Neugebauer E (1980) H1 + H2 receptor antagonists for premedication in anaesthesia and surgery: a critical view based on randomized clinical trials with haemaccel and various antiallergic drugs. Agents Actions 10:114

    Google Scholar 

  18. Lorenz W, Doenicke A, Schöning B, Neugebauer E (1980) The role of histamine in adverse reactions to intravenous agents. In: Thornton A (ed) Adverse reactions of anaesthetic drugs. Elsevier/North-Holland, Biomedical Press, p 169

    Google Scholar 

  19. Lorenz W, Doenicke A, Schöning B, Ohmann CH, Grote B, Neugebauer E (1982) Definition and classification of the histamine-release response to drugs in anaesthesia and surgery: Studies in the conscious human subject. Klin Wochenschr 60:896

    Google Scholar 

  20. Lorenz W, Röher HD, Doenicke A, Ohmann O (1984) Histamine release in anaesthesia and surgery: a new method to evaluate its clinical significance with several types of causal relationship. Clin Anaesthesiol 2:403

    Google Scholar 

  21. Moss J, Rosow CE (1983) Histamine release by narcotics and muscle relaxants in humans. Anesthesiology 59:330

    Google Scholar 

  22. Osswald PM, Meier C, Schmegg B, Hartung HJ (1987) Komplikationen der Anaesthesie bei Patienten im höheren Lebensalter. Anaesthesist 36:292

    Google Scholar 

  23. Philbin DM, Moss J, Akins CW, Rosow CE, Kono K, Schneider RC, Ver-Lee TR, Savarese JJ (1981) The use of H1- and H2-histamine blockers with high dose morphine anesthesia: a double blind study. Anesthesiology 55:292

    Google Scholar 

  24. Rbher HD, Lorenz W, Lennartz H, Kusche J, Dietz W, Gerdes B, Parkin JV (1982) Plasma histamine levels in patients in the course of several standard operations: influence of anaesthesia, surgical trauma and blood transfusion. Klin Wochenschr 60:926

    Google Scholar 

  25. Rosow CW, Moss J, Philbin DMD, Savarese JJ (1982) Histamine release during morphine and fentanyl anesthesia. Anesthesiology 56:93

    Google Scholar 

  26. Schöning B, Lorenz W, Doenicke A (1982) Prophylaxis of anaphylactoid reactions to a polypeptidal plasma substitute by H,- plus H2 receptor antagonists: synopsis of three randomized controlled trials. Klin Wochenschr 60:1048

    Google Scholar 

  27. Sertürner FWA (1817) Ober das Morphium, eine neue salzfähige Grundlage, und die Mekonsäure als Hauptbestandteil des Opiums. Annalen der Physik 55:56

    Google Scholar 

  28. Suttmann H, Doenicke A, Lorenz W, Ennis M, Müller OA, Dorow R, Ackenheil M (1986) Is perioperative stress a real surgical phenomenon or merely a drug-induced effect? A study comparing the actions of nalbuphine and morphine on subjective factors and endocrinological parameters in volunteers. Theor Surg 1:119

    Google Scholar 

  29. Thornton JA, Lorenz W (1983) Histamine and antihistamine in anaesthesia and surgery. Report of a symposium. Anaesthesia 38:373

    Google Scholar 

  30. Tryba M (persönliche Mitteilung)

  31. Watkins J, Thornton JA (1982) Immunological and non-immunological mechanisms involved in adverse reactions to drugs. Klin Wochenschr 60:958

    Google Scholar 

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Authors and Affiliations

  1. Institut für Anaesthesie der Ludwig-Maximilians-Universität München, Bereich Poliklinik, Pettenkoferstrasse 8a, D-8000, München 2

    A. Doenicke

  2. Institut für theoretische Chirurgie, Zentrum für Operative Medizin I, Klinikum der Philipps-Universität Marburg, D-3550, Marburg

    W. Lorenz

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Mit Unterstützung durch die Deutsche Forschungsgemeinschaft (Lo 199/14-2)

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Doenicke, A., Lorenz, W. 33. Prozesse des perioperativen Risikos aus der Sicht des Anaesthesisten. Langenbecks Arch Chiv 372, 217–225 (1987). https://doi.org/10.1007/BF01297817

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  • DOI: https://doi.org/10.1007/BF01297817

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