Modification of mediators of immune reaction after general anaesthesia.
The adverse reactions that may occur during a surgical intervention are of concern to anesthesiologists and allergists due to the civil responsibility they entail and the increased demand for healthcare in allergology units. The aim of the present study was to determine the prevalence of adverse reactions in our setting (Island of Lanzarote) and modifications to immune response mediators using three types of representative myorelaxants (succinylcholine, cisatracurium and vecuronium) in order to predict and prevent adverse reactions.


METHODS
We performed a prospective, cross sectional, observational study in a population of 201 patients scheduled to undergo surgery in the Surgery Department of the Lanzarote General Hospital from October 1998. Three groups were retrospectively selected: vecuronium (73 patients), cisatracurium (80 patients), and succinylcholine (48 patients). Blood was extracted from all patients before and after the intervention and the following in vitro variables were evaluated: histaminemia, eosinophil cationic protein, tryptase, IgE to latex, CD4/CD8 fractions, total lymphocytes, total IgE, C3 and C4, and also the histaminuria.


CONCLUSIONS
The mean age of the patients was 41 years with a predominance of women. Sixty percent had not previously undergone surgery. The mean operating time was 2 hours. Digestive surgery accounted for the greatest number of interventions (38.8 %) and most of the patients had no personal history of atopy (91.5 %). The greatest number of perioperative reactions was produced by cisatracurium (38.8 %), followed by succinylcholine (27.4 %) and vecuronium (20 %). The reactions observed were immediate type 1 and 2 reactions. All reactions were reversible without sequelae. Histaminuria levels were significantly decreased in the cisatracurium group. Histaminemia and eosinophil cationic protein showed no significant changes in any of the three groups. Tryptase concentrations in blood did not increase in the postoperative period in any of the three groups. On the contrary, concentrations were significantly lower than basal values. In the vecuronium and succinylcholine groups, CD4/CD8 fractions decreased in the postoperative period. Total lymphocytes decreased in all three groups. Total IgE tended to decrease in the cisatracurium and succinylcholine groups. IgE to latex was negative in the three groups. Specific IgE to succinylcholine was unmodified. C3 complement fraction was unmodified in all three groups and C4 fraction was reduced in the vecuronium group. In our setting and in our patients, the three myorelaxants produced immunosuppression of immune response mediators. The present study confirms that tests for allergy to myorelaxants are not indicated in the preoperative period.
Sánchez Palacios
A
A
Unidad de Alergología, Hospital Universitario Insular de G.C. Las Palmas, Gran Canaria, Spain. manuel.sanchezpalacios@gobiernodecarnarias.org
Ortiz Ponce
M
M
Rodríguez Pérez
A
A
Schamann Medina
F
F
García Marrero
J A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001279:Atracurium / Q000009:adverse effects* / Q000031:analogs & derivatives*; D016516:CD4-CD8 Ratio; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D003430:Cross-Sectional Studies; D004342:Drug Hypersensitivity / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D047150:Eosinophil Cationic Protein / Q000032:analysis; D005260:Female; D006632:Histamine / Q000097:blood / Q000652:urine; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D007958:Leukocyte Count; D016131:Lymphocyte Subsets / Q000187:drug effects; D008297:Male; D008407:Mast Cells / Q000201:enzymology; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D011300:Preoperative Care; D015995:Prevalence; D011446:Prospective Studies; D012697:Serine Endopeptidases / Q000032:analysis; D013390:Succinylcholine / Q000009:adverse effects*; D053802:Tryptases; D014673:Vecuronium Bromide / Q000009:adverse effects*
D003176:Complement C3; D003181:Complement C4; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D007073:Immunoglobulin E; D014673:Vecuronium Bromide; D006632:Histamine; D047150:Eosinophil Cationic Protein; D012697:Serine Endopeptidases; D053802:Tryptases; D013390:Succinylcholine; C101584:cisatracurium