Histamine release is associated with hemodynamic instability. It may be triggered by many drugs used in anesthesia and these must be avoided.
Drugs that can trigger histamine release and/or anaphylaxis:
(1) vancomycin
(2) polymyxin B sulfate
(3) sodium thiopental
(4) procaine, tetracine and methylparaben
(5) morphine, codeine, meperidine
(6) many neuromuscular blocking agents, including alcuronium, d-turbocurarine, decamethonium, gallamine, pancuronium and succinylcholine
(7) papaverine
(8) atropine
(9) protamine sulfate
(10) ketamine
(11) dextran
Concerns for a patient with urticaria pigmentosa during surgery:
(1) avoidance of histamine release following mast cell degranulation
(2) muscle relaxation, which is best achieved with vecuronium
(3) normothermia
(4) avoidance of mechanical trauma or skin irritation
(5) perioperative administration of H1 and H2-receptor antagonists or disodium chromoglycate
(6) invasive hemodynamic monitoring
(7) ready availability of catecholamines, antihistamines and bronchodilators if resuscitation is needed
