H1- and H2-receptor antagonists prevent histamine release in allergic patients after the administration of midazolam-ketamine. A randomized controlled study

Abstract

The administration of midazolam-ketamine in allergic patients demonstrated no significant problems. The combined premedication with chlorpheniramine and famotidine was thus found to have the most prophylactic effect against histamine release after the administration of midazolam-ketamine in allergic patients in spite of a high level of basal plasma histamine.

Effect of H1- and H2-receptor antagonists on the hemodynamic changes induced by the intravenous administration of ketamine in sevoflurane-anesthetized cats

“…Such trend in the AH group has also been described by other authors [11,13,14], and might partly explain the observed differences in the HR and the MAP among groups. However, the resemblance in the histamine fluctuation pattern in both groups allows for comparisons between the ketamine effects on the hemodynamics.…”

“…Therefore, antihistamines rather than prevent the ketamine-induced hemodynamic changes cause a more pronounced depression, and most probably such effect is mainly due to the actual blockade of the histamine receptors [15]. Kimura et al [11] found a similar trend by means of a different experimental approach, since they observed that antihistamine treatment prevented the heart rate increase induced by ketamine-midazolam administration.…”

“…Irman-Florjanc [8] reported an analogous pattern in cats under ketamine/medetomidine anesthesia. Similarly, in a more recent study, the administration of midazolam-ketamine to allergic humans caused an increase of the plasma histamine above 1 ng/ml in 6 out of 9 patients [11], a level which is considered to have an adverse clinical impact in anesthetized patients [12]. In parallel to the fluctuation of the histamine concentration, ketamine injection under sevoflurane anesthesia caused a rapid hypotension without changes in the HR in the control untreated cats.…”

Histamine release during the induction of anesthesia with propofol in allergic patients: A comparison with the induction of anesthesia using midazolam-ketamine

“…Since midazolam attenuated both the cardiostimulatory responses and unpleasant emergence associated with ketamine [36], the combination of midazolam and ketamine has been recommended for total intravenous anesthesia [13][14][15]. In our previous study, the induction of anesthesia with midazolam-ketamine was shown to be useful for allergic patients without any significant problems [16]. According to Pedersen et al [37], propofol was shown to be able to directly relax guinea pig tracheal tissue, which was more potent than ketamine.…”

“…The induction of anesthesia with midazolam-ketamine has been shown to be useful for patients with a history of allergy, in our previous study [16]. However, the use of propofol for anesthesia in allergic patients has not yet been clarified.…”