Histamine release in mesenteric traction syndrome during abdominal aortic aneurysm surgery: prophylaxis with H1 and H2 antihistamines.
OBJECTIVE
Mesenteric traction syndrome is described as sudden tachycardia, hypotension and flush. Among other etiological factors eventeration or mesenteric traction of the small intestine may cause histamine release from mesenteric mast cells. We hypothesized that mesenteric traction syndrome may be positively influenced by prophylactic antihistamine administration.


METHODS
Male patients (n = 17, ASA groups III-IV, 48-78 years old) were investigated in a randomised double blind study during elective abdominal aortic aneurysm (AAA) repair. Eight patients had pre-anaesthetic prophylaxis with dimetindene (H1-receptor antagonist) plus cimetidine (H2-receptor antagonist), 9 patients received placebo. Anaesthesia and invasive haemodynamic monitoring were standardised in all patients. Haemodynamic parameters, plasma histamine concentrations and clinical symptoms were determined 1 min after skin incision, as well as 5 and 20 min after mesenteric traction. Statistical analyses were performed using the Student's t-test, Chi2-test for incidences and Mann-Whitney-U-test for continuous data.


RESULTS
The incidence of histamine release was 55.5% (5/9) in the placebo group vs. 37.5% (3/8) in the antihistamine group (p > 0.05, Chi2-test). Plasma histamine levels (mean +/- SD) were higher in the placebo group than in the antihistamine group at 5 and 20 min after mesenteric traction but the difference did not reach statistical significance. Arrhythmias were significantly more frequent in the placebo group (6 times) than in the antihistamine group (none) (p = 0.005 Chi2-test). Systolic blood pressure was not statistically different between groups (e.g. 5 min after mesenteric traction, mean +/- SD; placebo 111 +/- 20 mm Hg vs. antihistamines 119 +/- 35 mm Hg). However, in the placebo group the haemodynamics only stabilised 5 min after mesenteric traction when anaesthetic gas concentration was repeatedly reduced and vasopressor/volume administration was increased (placebo-group = 20 times/antihistamine-group = 8 times, p = 0.001, t-test).


CONCLUSIONS
Prophylactic administration of antihistamines reduced the incidence of histamine release as well as the incidence of arrhythmias and the amount of stabilising measures during mesenteric traction. Prophylaxis with H1 and H2 antihistamines may be of perioperative benefit and should therefore be considered in AAA-surgery.
Duda
D
D
Department of Anaesthesiology, St Hildegardis-Academic Hospital of the Johannes Gutenberg-University, DE-55131 Mainz, Germany. duda@mail.uni-mainz-de
Lorenz
W
W
Celik
I
I
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000502:physiology; D002927:Cimetidine / Q000494:pharmacology; D004115:Dimethindene / Q000494:pharmacology; D004311:Double-Blind Method; D005483:Flushing / Q000378:metabolism* / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006634:Histamine H1 Antagonists / Q000494:pharmacology*; D006635:Histamine H2 Antagonists / Q000494:pharmacology*; D006636:Histamine Release / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000378:metabolism* / Q000503:physiopathology; D007431:Intraoperative Complications / Q000378:metabolism* / Q000503:physiopathology; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D013152:Splanchnic Circulation / Q000502:physiology*; D013577:Syndrome; D013610:Tachycardia / Q000378:metabolism* / Q000503:physiopathology; D014656:Vascular Surgical Procedures
D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D004115:Dimethindene; D002927:Cimetidine