Histamine release in paediatric cardiopulmonary bypass —a possible role in the capillary leak syndrome

Abstract

Recent studies have reported pathologically elevated plasma histamine levels in adult patients during and after open heart surgery. In paediatric practice, the increased use of donor-blood primes might be expected to produce even greater rises in the histamine levels, by creating histamine release in the prime before initial perfusion commences. The present study covered 40 arbitrarily chosen paediatric cases. Pathologically elevated plasma histamine levels (greater than 1 ng/ml) were found in the prime of 26 out of 37 cases (73%). Histamine levels were substantially higher than levels encountered in previously reported studies, and massively elevated prime histamine levels (greater than 80 ng/ml) were encountered in 9 out of the 40 cases (22%). These results suggest that in conventional paediatric cardiac surgical practice, the prime content of histamine is markedly elevated in the majority of patients. The inevitable delivery of this prime histamine load at the onset of perfusion might be expected to produce systemic pathological effects.

The isolated blood‐perfused rat heart: an inappropriate model for the study of ischaemia‐ and infarction‐related ventricular fibrillation

“…The identity of the vasoactive mediators responsible for each effect is unknown, but release of a wide range of possible candidate substances has been observed during cardiopulmonary bypass operations where blood is passed through an extracorporeal circuit (Downing & Edmunds, 1992). These include bradykinin (Cugno et al ., 1999; Nagaoka et al ., 1975), histamine (Marath et al ., 1987; Withington & Aranda, 1997) prostacyclin (Teoh et al ., 1987) and PGE 2 (Lajos et al ., 1985). Additionally thromboxane A 2 may be released from platelets (Teoh et al ., 1987).…”

Postpartum systemic capillary leak syndrome: a possible etiology

“…However, an inflammatory/allergic mechanism seems most reasonable. Histamine (16), interleukin 2 (171, tumor necrosis factor (18), complement factors ( 19), bradykinine (20) and paraproteins ( 5 ) have been suggested to play a role in the induction of the vascular leak process. In the case presented here high serum soluble in-.…”

Histamine in Anaesthesia and Surgery: Causality Analysis

“…This work was systematically extended over the next 15 years (KUSCHE et al 1977a,b;THERMANN et al 1978;KUSCHE et al 1978KUSCHE et al , 1979ROHER et al 1982;Lorenz et al 1984b;DIETZ et al 1984;KUSCHE et al 1985;DOENICKE et al 1985;LORENZ and DOENICKE 1985a;STAHLKNECHT et al 1985;DIETZ et al 1988;LINDLAR et al 1989). Recently this approach was taken up very successfully by the Hammersmith group, mainly in cardiac and transplantation surgery (MARATH et al 1987(MARATH et al , 1988aHANSEN et al 1988;STEGER et al 1989;TIMONEY et al 1989). Hence it is now possible to demonstrate a large variety of situations in the operating theatre where free histamine appears in the circulation and to stimulate even more research in this almost endless field.…”

“…Wellknown examples are the various types of extracorporeal circulation with tubes made from artificial, non-biological materials (LORENZ et al 1973a;MARATH et al 1987MARATH et al , 1988a (Fig. 10).…”