Abstract
Purpose
Histamine release has been previously documented in adults and children during cardiopulmonary bypass (CPB). It has not been studied in neonates nor during deep hypothermic circulatory arrest (DHCA). Histamine effects could explain many penoperative complications of congenital cardiac surgery such as dysrhythmias and massive oedema. Therefore, documentation of histamine release in the penoperative period is of clinical importance. The source of histamine can be determined by measurement of tryptase which is released with histamine from mast cells but not basophils.
Methods
Blood samples for histamine and tryptase were taken before and after specific events eg. cross-damp removal, during anaesthesia and CPB in 14 infants and seven neonates undergoing complex congenital heart repairs and were analysed by commercial radiommunoassays. Haemodynamic variables and pre and post-op weights were recorded to look for correlation between pathophysiologcal events and histamine release.
Results
Histamine concentration decreased at the start of bypass (0.69 to 0.38 ng · ml−1 at five minutes, (P < .005). There were no changes associated with DHCA and a small rise with reventilation (P < 0.02). Histamine concentration was lower in neonates than in infants (P < 0.05) during CPB. Plasma histamine and tryptase concentrations did not correlate, suggesting histamine release was from basophils and not from mast celts. Haemodynamic variables did not correlate with histamine concentrations.
Conclusion
There was no major histamine release during CPB in infants and neonates. There was no relationship between histamine concentrations and dinical variables. Histamine released during CPB appears to come from basophils and may be a function of age.
Résumé
Objectif
La libération d’hrstamine a déjà été documentée chez des enfants et des adultes pendant la circulation extracorporelle (CEC). Elle n’a pas été recherchée chez les nouveau-nés ou pendant l’arret circulatore en hypothenmie profonde (ACHP). Les effets de l’histamine pourraient expliquer plusieurs des complictions postopératoires de la chirurgie des cardiopathies congénitales comme les dysrythmies et l’oedème pulmonaire massif. Il est donc important du point de vue dinique de corroborer la libération d’histamine à la période périopératoire. La source de l’histamine peut être déterminée par le dosage de la tryptase libérée avec l’histarnine par les mastocytes mais non les basophiles.
Méthodes
Des échantions sangums ont été prélevés pour le dosage de l’histamine et de la tryptase avant et après des événements spécifiques, per ex. le retrait du damp aortique, pendant l’anesthésie et la CEC, diez 14 enfants et sept nouveau-nés sournis des correction chinurgicales de malformation corgénitale compliquées. Les échantillons ont été analysés par dosage radioirnmunologique. Les variables hémodynarniques et les pesées pré- et postopératoires ont été enregistrées pour rechercher une corrélation entre les événements physiopathologiques et la libération d’histamine.
Resultats
La concentration d’histamine a diminué au début de la CEC de 0,69 à 0,38 ng · ml−1 à la cinquième minute (P < 0,005). Aucun changement n’a été associé à l’ACHP. Une légère augmentation est survenue avec la reprise de la ventilation (P < 0,02). Rendant la CEC, les concentrations d’histamine des enfants étaient inférieures à celles des nouveau-nés (P < 0,05). Il n’y avait pas de corrélation entre les concentrations de tryptase et d’histamine, suggérant ainsi que l’histamine était libérée à partir des basophites plutôt que des mastocytes. Les variables hérnodynamique ne corréiaient pas avec les concentrations d’histamine.
Conclusion
On n’a pas noté de libération importante d’histamine pendant la CEC chez les enfants et les nouveaunés. L’histamine libérée semble provenir des basophiles et pourrait être en fonction de l’âge.
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Supported by the Heart and Stroke Foundation of Québec.
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Withington, D.E., Anuida, J.V. Histamine release during cardiopulmonary bypass in neonates and infants. Can J Anaesth 44, 610–616 (1997). https://doi.org/10.1007/BF03015444
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DOI: https://doi.org/10.1007/BF03015444