Effects of promethazine or dexamethasone pretreatment on mivacurium‐induced histamine release in children

Zhou, Xiang; Qu, Yue; Song, Xiaofeng; Zhang, Yanhui; Chen, Min; Guo-shen, Gan; Wu, Mingchun; Luo, Zhitian; Wang, Qingli; Guang-Jun, Hu; Qin, Mingzhe; Tao, Jun

doi:10.1111/pan.12305

Cited by 10 publications

(11 citation statements)

References 14 publications

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“…None of the serious adverse events were seen to be related to mivacurium. However, due to children’s immature cardiovascular and respiratory systems, adverse events associated with histamine release from mivacurium pose a greater risk to pediatric patients [13]. …”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of mivacurium in pediatric patients

et al. 2017

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BackgroundMivacurium is the shortest acting nondepolarizing muscle relaxant currently available; however, the effect of different dosages and injection times of intravenous mivacurium administration in children of different ages has rarely been reported. This study was aimed to evaluate the muscle relaxant effects and safety of different mivacurium dosages administered over different injection times in pediatric patients.MethodsSix hundred forty cases of pediatric patients, aged 2 m-14 years, ASA I or II, were divided into four groups (Groups A, B, C, D) according to the age class (2–12 m, 13–35 m, 3–6 years and 7–14 years) respectively, also each group were divided into four subgroups by induction dose (0.15, 0.2 mg/kg in 2–12 m age class; 0.2, 0.25 mg/kg in other three age classes), and mivacurium injection time (20 s, 40 s), totally 16 subgroups. Neuromuscular transmission was monitored with supramaximal train-of-four stimulation of the ulnar nerve. Radial artery blood (1 ml) was sampled to quantify plasma histamine concentrations before and 1, 4, and 7 min after mivacurium injection (P0, P1, P2 and P3).ResultsFive hundred sixty-two cases completed the study. There were no demographic differences within the four groups. The onset time of 0.2 mg/kg groups in 2–12 m aged patients were shorter than those of 0.15 mg/kg groups (189 ± 64 s vs. 220 ± 73 s, 181 ± 60 s vs. 213 ± 71 s, P <0.05), and the recovery times were no statistical differences. The T1 25% recovery time of 0.2 mg/kg in 3–6 years aged patients was shorter than that of 0.25 mg/kg group (693 ± 188 s vs. 800 ± 206 s, P <0.05). The onset and recovery times of mivacurium were not different in 13–35 m and 7–14 years aged patients. The plasma concentrations of histamine at P0, P1, P2 and P3 were not different within four groups.ConclusionsThe induction dose and injection time of mivacurium had mostly insignificant effects on onset and recovery times. The main exception to this was that in 2–12 m aged patients, increasing the dose of mivacurium from 0.15 to 0.2 mg/kg accelerated the onset time by about 30 s. Mivacurium produced no significant release of histamine in any age group at the doses studied.Trial registrationClinicalTrials.gov Identifier-NCT02117401, July 14, 2014. (Retrospectively registered)

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Section: Discussionmentioning

confidence: 99%

The efficacy and safety of mivacurium in pediatric patients

et al. 2017

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“…There are different possibilities: c) In cases where non-specific histamine release is suspected the recommendation is to avoid drugs with potent histamine release capacity in next anaesthesia. Pre-treatment with antihistamines is also recommended [11,153] and all drugs should be administered slowly and one by one [10,145] (grade of recommendation, D).…”

Section: Recomendations After the Allergological Studymentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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“…Elevated histamine levels were frequently observed when measured, sometimes in more than 50% of patients (70)(71)(72)(73). Flushing/erythema has been observed in from 6% to 73% of patients (70)(71)(72)(74)(75)(76)(77)(78)(79)(80)(81)(82). MAP changes also occur at a lesser frequency, from 0% to 50% (70,72,73,77,(80)(81)(82)(83).…”

Section: Allergic-type Event Frequency and Mast Cell Dependencementioning

confidence: 97%

“…Mivacurium injection is associated with elevated plasma histamine levels, flushing/erythema, and drops in mean arterial pressure (MAP) of greater than 20%, which all correlate with the speed of injection and drug dose. Elevated histamine levels were frequently observed when measured, sometimes in more than 50% of patients (70)(71)(72)(73). Flushing/erythema has been observed in from 6% to 73% of patients (70)(71)(72)(74)(75)(76)(77)(78)(79)(80)(81)(82).…”

Section: Allergic-type Event Frequency and Mast Cell Dependencementioning

confidence: 99%

“…Flushing/erythema has been observed in from 6% to 73% of patients (70)(71)(72)(74)(75)(76)(77)(78)(79)(80)(81)(82). MAP changes also occur at a lesser frequency, from 0% to 50% (70,72,73,77,(80)(81)(82)(83). Studies that examined all at once found that MAP changes nearly always were accompanied by flushing and histamine release (70,73,78).…”

Section: Allergic-type Event Frequency and Mast Cell Dependencementioning

confidence: 99%

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MRGPRX2 and Adverse Drug Reactions

McNeil

2021

Front. Immunol.

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Many adverse reactions to therapeutic drugs appear to be allergic in nature, and are thought to be triggered by patient-specific Immunoglobulin E (IgE) antibodies that recognize the drug molecules and form complexes with them that activate mast cells. However, in recent years another mechanism has been proposed, in which some drugs closely associated with allergic-type events can bypass the antibody-mediated pathway and trigger mast cell degranulation directly by activating a mast cell-specific receptor called Mas-related G protein-coupled receptor X2 (MRGPRX2). This would result in symptoms similar to IgE-mediated events, but would not require immune priming. This review will cover the frequency, severity, and dose-responsiveness of allergic-type events for several drugs shown to have MRGPRX2 agonist activity. Surprisingly, the analysis shows that mild-to-moderate events are far more common than currently appreciated. A comparison with plasma drug levels suggests that MRGPRX2 mediates many of these mild-to-moderate events. For some of these drugs, then, MRGPRX2 activation may be considered a regular and predictable feature after administration of high doses.

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Effects of promethazine or dexamethasone pretreatment on mivacurium‐induced histamine release in children

Abstract: Pretreatment with promethazine significantly decreased mivacurium-induced histamine release in children and provided stable hemodynamics during administration of anesthesia.

Cited by 10 publications

References 14 publications

The efficacy and safety of mivacurium in pediatric patients

The efficacy and safety of mivacurium in pediatric patients

Practical Guidelines for Perioperative Hypersensitivity Reactions

MRGPRX2 and Adverse Drug Reactions

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