Plasma histamine profiles in paediatric cardiopulmonary bypass

Abstract

We have previously reported our findings of very high plasma histamine levels in the extracorporeal blood primes of infants undergoing cardiopulmonary bypass (CPB) for correction of congenital cardiac defects and have now extended this enquiry to examine the whole peri-operative period. In this preliminary study, samples of blood for plasma histamine were drawn from a mixed group of congenital cardiac patients featuring varying degrees of cyanosis, differing hypothermic operative conditions and utilising two oxygenator systems. Despite the diversity of this group a common pattern of histamine release emerged with a clear origin at the commencement of bypass, and continuing during the operative period. Our results suggest that priming procedures using stored donor blood provide a major contributing source of histamine release with inevitable deleterious consequences to the post-operative outcome.

Open heart surgery increases the levels of histamine in arterial and coronary sinus blood

“…As the patients included in the present study suffered from coronary atherosclerotic disease, the increased histamine in the coronary circulation during reperfusion may induce vasoconstriction. Elevated arterial histamine levels have previously been found in dogs on CPB [20], and in both adults [23] and children [21,22] during open heart surgery. The observed increase in plasma histamine may be influenced by (1) anesthesia, (2) major surgery, and (3) effects of cardiopulmonary bypass per se.…”

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.…”

“…10), haemofiltration, etc. simply by the use of new materials in the extracorporeal circulation (MARATH et al 1988a) and will leave it if the risk of mediator release by these materials is recognized and thereafter removed by a new technology (socalled "treatment paradox"). It is the sum of these histamine release or histamine administration situations which we consider as clinically relevant although the outcome studies on this problem are not yet completed .…”

“…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).…”

Paediatric extracorporeal priming procedures: does low temperature priming promote histamine release?

“…Two types of extracorporeal circuit systems featured in the study (Terumo, Japan and Bentley, UK manufacturers) and were used in their three available sizes, namely, Capiox 8,16 and 33 (Terumo) and Bos 2, 5 and 10 (Bentley), chosen according to the discretion of the perfusionists, stock availability of the two systems, and the calculated surface area of the particular patient.…”