pancuronium and Erythema

Sixty patients scheduled for elective surgery underwent intradermal testing with 0.1 ml of the following solutions diluted in 0.9% saline: vecuronium and tubocurarine (1 in 1,000), atracurium (1 in 1,000 and 1 in 10,000), thiopentone (1 in 100) and also a 0.9% saline control. Thirty minutes later, an area of erythema of greater than 1.5 cm, or a wheal exceeding 1.0 cm in diameter, was recorded as a positive reaction. The patients then randomly received equipotent doses of atracurium, vecuronium or tubocurarine during a standardized anaesthetic induction. Any cutaneous reaction and the percentage fall in systolic pressure three minutes after administration of the relaxant were recorded. In 51 patients plasma IgE levels were measured. The incidence of positive cutaneous reactions to intradermal and intravenous relaxants was significantly different with each agent (p less than 0.01). The percentage fall in systolic pressure after tubocurarine was significantly different relative to the other two agents (p less than 0.01). This was regarded as reflecting potency in releasing histamine and placed the relaxants in the same order: tubocurarine, atracurium and vecuronium. The response to intradermal administration was no guide to the subsequent response after intravenous administration of the three relaxants. IgE levels below 15 IU X ml-1 occurred significantly more often in females and were associated with a significantly higher incidence of cutaneous reactions after intradermal atracurium (1 in 1,000 and 1 in 10,000) (p less than 0.05 and 0.001 respectively) and tubocurarine (1 in 1,000). With these two agents, generalized flushing after intravenous administration was also more common in this group, relative to the normal/high IgE group.

Topics: Adult; Aged; Atracurium; Blood Pressure; Clinical Trials as Topic; Drug Eruptions; Erythema; Histamine Release; Humans; Immunoglobulin E; Isoquinolines; Middle Aged; Neuromuscular Blocking Agents; Pancuronium; Skin Tests; Tubocurarine; Vecuronium Bromide

The effects of five commonly used neuromuscular blocking drugs on histamine liberation were studied in 105 surgical patients. After standard premedication with pethidine and atropine the patients were anaesthetized with thiopental sodium. d-Tubocurarine and succinylcholine caused significant histamine liberation while alcuronium, gallamine, and pancuronium did not appear to exert this effect. d-Tubocurarine seems to liberate histamine by acting directly on the blood cells thus causing a decrease of histamine in the whole blood and an elevation in plasma. On the other hand, the succinylcholine-induced liberation of histamine may be mediated by muscular fasciculations as it causes an elevation of histamine in whole blood and in plasma. No correlation was found between histamine liberation and blood pressure changes. Erythematous skin reactions were the only clinical sign of histamine liberation caused by intravenous administration of the neuromuscular blocking drugs.

Topics: Adult; Alcuronium; Blood Pressure; Erythema; Female; Gallamine Triethiodide; Heart Rate; Histamine Release; Humans; Leukocyte Count; Male; Middle Aged; Neuromuscular Blocking Agents; Pancuronium; Platelet Count; Succinylcholine; Tubocurarine

Topics: Adult; Drug Eruptions; Erythema; Hand Dermatoses; Humans; Male; Pancuronium