Different patterns of mast cell activation by muscle relaxants in human skin.
BACKGROUND
Activation of mast cells and systemic release of histamine are major side effects of intravenously administered muscle relaxants. In the current study, dermal microdialysis was used for the investigation of mast cell activation by muscle relaxants. Dermal microdialysis enabled simultaneous assessment of mediator release, vascular reactions, and sensory effects induced by intradermal application of muscle relaxants without systemic side effects.


METHODS
Succinylcholine, the isoquinolines cisatracurium, atracurium, and mivacurium, and the steroids pancuronium, vecuronium, rocuronium, and rapacuronium were tested in human volunteers (n = 6 each). After intradermal insertion of microdialysis capillaries (0.4 mm diameter, cutoff 3,000 kd) and a 60-min equilibration period, the muscle relaxants were delivered via the capillaries for 30 min, followed by a 30-min washout period. Dialysate was sampled at 15-min intervals, and histamine, mast cell tryptase, and protein extravasation were determined. Changes in skin blood flow were measured using a laser Doppler imager. Potency and efficacy were derived from nonlinear fittings of the dose-response curves.


RESULTS
For succinylcholine and the isoquinolines, dose-response curves for the vascular and sensory effects paralleled the histamine and tryptase release. In contrast, aminosteroids evoked a rapid histamine release that was accompanied by a delayed increase in tryptase.


CONCLUSIONS
Dermal microdialysis has been successfully used to simultaneously assess mediator release, vascular reactions, and sensory effects. The different pattern of tryptase release by isoquinolines and aminosteroids suggests different mechanisms of mast cell activation.
Koppert
W
W
Department of Anesthesiology, University of Erlangen-Nuremberg, Germany.
Blunk
J A
JA
Petersen
L J
LJ
Skov
P
P
Rentsch
K
K
Schmelz
M
M
D000328:Adult; D001279:Atracurium / Q000031:analogs & derivatives / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006636:Histamine Release / Q000187:drug effects; D006801:Humans; D008297:Male; D008407:Mast Cells / Q000187:drug effects* / Q000502:physiology; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D012039:Regional Blood Flow / Q000187:drug effects; D012697:Serine Endopeptidases / Q000378:metabolism; D012867:Skin / Q000098:blood supply / Q000187:drug effects*; D013390:Succinylcholine / Q000494:pharmacology; D053802:Tryptases
D009466:Neuromuscular Blocking Agents; D001279:Atracurium; D012697:Serine Endopeptidases; D053802:Tryptases; D013390:Succinylcholine; C101584:cisatracurium