Biomedical subjects

J M Hermens

Publications and source records attributed to J M Hermens.

4 recordsLinked to original sources

PubMed1986

Functional differences between human cutaneous mast cells and basophils: a comparison of morphine-induced histamine release.

Intravenous administration of morphine sulfate often produces urticarial and hypotensive reactions associated with elevations in plasma histamine. The source of this histamine and mechanisms controlling its release are poorly understood. Previous studies of morphine-induced histamine release compared human leukocytes to rat peritoneal mast cells. The effects of morphine on human cutaneous mast cells has not been examined. We studied in vitro histamine release from human basophils and human skin preparations containing cutaneous mast cells to evaluate their relative contribution to the pharmacologic effects of morphine. Human skin mast cell preparations showed dose-dependent histamine release over a morphine concentration range of 1.5 X 10(-5) to 4.5 X 10(-3) M, with peak release occurring at 5 X 10(-4) M, with peak release occurring at 5 X 10(-4) M. Clinically, morphine sulfate is usually injected as a 1.5 X 10(-2) M solution. Histamine release was calcium dependent and equivalent to that obtained with 3 and 10 mM strontium. Morphologic examination revealed degranulation and exocytosis occurring in morphine-stimulated tissue but not in specimens exposed to buffer alone. Lactate dehydrogenase levels did not increase following morphine incubation, thus supporting a noncytolytic mechanism of histamine release. Basophils, in contrast, showed no significant histamine release from exposure to morphine up to 10(-2) M. Concanavalin A, as a positive control in these same preparations, produced a mean histamine release of 21.0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Basophils↗

PubMed1985

Comparison of histamine release in human skin mast cells induced by morphine, fentanyl, and oxymorphone.

Human leukocyte and skin mast cell preparations were incubated with morphine sulfate in concentrations ranging from 1.5 X 10(-5) M to 4.5 X 10(-3) M. Skin mast cells also were incubated with oxymorphone and fentanyl in the same concentrations. Human leukocytes did not release histamine in response to any concentration of morphine. In skin mast cells, histamine release by morphine first was detected at 1.5 X 10(-4) M. Histamine release further increased at 5.0 X 10(-4) M with no incremental increase at higher concentrations. Oxymorphone and fentanyl failed to release histamine at any concentration. Histamine release by morphine required calcium but was not influenced by changes in the 1-4 mM range. Skin mast cell preparations were pretreated for 30 min in naloxone 5 X 10(-4) M and then morphine 5 X 10(-4) M was added for 30 min without removing naloxone. Naloxone neither released histamine nor inhibited morphine-induced histamine release. The release of histamine by morphine but not equimolar concentrations of fentanyl and oxymorphone indicates that histamine release by narcotics is not a nonspecific effect of high drug concentration. The failure of naloxone to inhibit morphine-induced histamine release suggests that histamine release by morphine is not dependent on opiate receptor binding or activation. These results indicate that this human mast cell preparation will be useful in further understanding the mechanism of histamine release induced by morphine and other agents.

Cell Membrane↗

PubMed1984

Inhalational anesthesia and histamine release during bronchospasm.

The influence of inhalational anesthetics on histamine released during bronchospasm induced by Ascaris antigen aerosol was studied in Basenji-Greyhound (BG) dogs. Five BG dogs were anesthetized with thiopental and halothane on separate occasions and challenged with Ascaris antigen aerosol for five minutes. Pulmonary resistance (RL), dynamic compliance (Cdyn), and arterial plasma histamine levels were measured over 30 min following antigen exposure. Prior to antigen challenge, RL, Cdyn, and histamine levels were similar in thiopental- and halothane-anesthetized dogs. The peak change in RL and Cdyn occurred 10 min after the start of antigen challenge. RL increased 3.0 +/- 0.4-fold (mean +/- SEM) in thiopental-anesthetized dogs as compared with 1.6 +/- 0.2-fold in halothane-anesthetized dogs (P less than 0.05). Cdyn decreased to a similar extent in both groups, with maximal decreases of 0.53 +/- 0.08 and 0.53 +/- 0.09 times the prechallenge value for thiopental- and halothane-anesthetized dogs, respectively. Plasma histamine levels peaked at 5 min. Plasma histamine increased to 8.0 +/- 5.0 ng/ml in thiopental-anesthetized dogs compared with 10.7 +/- 4.7 ng/ml in halothane-anesthetized dogs. Histamine levels were not significantly different during or after antigen challenge between thiopental- and halothane-anesthetized dogs. Halothane, but not thiopental, significantly attenuated the increase in RL provoked by antigen challenge. However, arterial plasma histamine levels were similar during both anesthetics. Therefore, the authors conclude that the protective effect of halothane on airways was not due to an inhibition of release of histamine from mast cells.

Anesthesia, Inhalation↗

PubMed1983

Anesthesia for laser surgery.

Laser surgery offers several advantages to the surgeon and patient: microscopic precision, a bloodless operative field, and complete sterility. While the majority of procedures pose few problems beyond protection of the eyes of operating room personnel and patients, microlaryngeal surgery with the CO2 laser requires very careful anesthetic management. A preoperative visit to determine the degree of existing airway obstruction is mandatory in deciding the safest anesthetic technique. Continued communication and cooperation between the surgeon and anesthesiologist throughout the procedure will help minimize the conflicting needs for airway access and ventilation. We feel the best approach to the anesthetic management of patients undergoing laser airway surgery is to have several alternatives available at the time of induction of anesthesia. For adult patients wrapped tubes, metal tubes, and a jet injector should be on hand. The options are more limited in children. The smallest metal tubes available have external diameters of 6 mm (Norton tube) or 7 mm (Porch tube), which are too large to use in these younger patients. Small wrapped, uncuffed tubes or Venturi ventilation through a small-gauge needle are most often used. Regardless of the technique, constant vigilance throughout the procedure is required to detect complications early. Wrapped tubes, metal tubes, insufflation using no tube, and jet ventilation using a needle or metal tube reduce the fire hazard but each method substitutes its own set of problems. Before adopting any approach, we strongly recommend that the equipment selected be tested for flammability with the laser before its use in patients. If, in spite of precautions, ignition of equipment does occur, immediately interrupt the flow of oxygen and nitrous oxide as most materials do not burn readily in air. Then remove the offending material. We have reviewed selected aspects of the management of the patient undergoing laser surgery, outlined the principles of laser technology, and listed the many surgical procedures employing lasers. Also, recommendations on anesthetic management of microlaryngeal surgery with the CO2 laser with emphasis on currently available measures to prevent problems were reviewed in light of our own experience with this technique along with a summary of the literature on laser surgery. An understanding of the fundamental principles and applications of lasers will hopefully lead to safer patient care.

Anesthesia↗