Histaminoid response after intradermal and intravenous administration of atracurium, vecuronium and tubocurarine: a comparative study.
The object of this study was to investigate the histaminoid responses after intradermal administration of atracurium, vecuronium and tubocurarine and to compare these with the cutaneous and cardiovascular responses to intravenous administration of the above relaxants in the same patients. Positive local cutaneous responses to intradermal injection were most common after tubocurarine (92%) and least common after vecuronium (12%). Tubocurarine produced the greatest fall in systolic pressure 3 min after intravenous administration but there was no difference in this respect between atracurium and vecuronium. In any individual patient the response to intradermal injection of a relaxant was not a reliable predictor of the response to subsequent intravenous administration of the same relaxant. Twenty patients had plasma IgE levels below 12 IU ml-1. This abnormally low titre occurred more frequently in female patients and was associated with an increase in the incidence and degree of histaminoid responses to atracurium and tubocurarine. Low plasma IgE may be associated with a deficiency in surface IgE on mast cells which therefore have an increased sensitivity to drugs that cause direct pharmacological histamine liberation.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001279:Atracurium / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006636:Histamine Release / Q000187:drug effects*; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis; D007271:Injections, Intradermal; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D014403:Tubocurarine / Q000008:administration & dosage / Q000494:pharmacology*; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000494:pharmacology*
D001279:Atracurium; D007073:Immunoglobulin E; D014673:Vecuronium Bromide; D014403:Tubocurarine