Agents and actions. Supplements
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Agents Actions Suppl. · Jan 1991
Randomized Controlled Trial Clinical TrialControlled clinical trials and cross-sectional studies with plasma histamine measurements and histamine receptor antagonists: solving the problem of preoperative H1- + H2-prophylaxis by asking new questions?
The problem of a preoperative histamine H1- + H2 - prophylaxis was tackled by a group of new studies including randomized controlled clinical trials and cross-sectional studies with plasma histamine measurements and administration of H1- + H2 - antagonists to a control group. The first study demonstrated serial histamine release in the induction of anaesthesia up to 4 times in a single patient. Basal plasma histamine levels in resting subjects fell below 100 pg/ml during the time necessary for preparation of the surgical patient. ⋯ Sometimes tachycardia and hypertension produce the highest likelihood ratio, sometimes tachy- and bradycardia, but no changes in blood pressure as in the case of atracurium. It is concluded that the reasons why histamine release in anaesthesia and surgery is so much underreported and under-estimated include the present paradigms about plasma histamine levels and the "classical picture" of histamine release. Both are no longer valid and need a re-assessment.
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Inflammatory pain is mediated from the periphery by a specialized subgroup of nerve fibers, the nociceptors. The nociceptive nerve endings undergo sensitization and excitation when stimulated with inflammatory agents. ⋯ Since nociceptive nerve endings are too small to be approached directly with the methods of intracellular electrophysiology, one has to extrapolate to the membrane channels and intracellular processes mediating nociceptor sensitization from studies on the perikarya of sensory ganglion cells. Sustained inflammation induces profound plastic changes in peripheral and central neurones leading to an altered excitability.