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The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 881-886, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NM Katz, YD Kim, R Siegelman, SA Ved, SW Ahmed and RB Wallace
Protamine administration for heparin reversal after cardiopulmonary bypass
on occasion is associated with mild to severe hemodynamic deterioration.
The route of administration may modify these reactions. A prospective
randomized study was done in 68 patients undergoing isolated coronary
artery bypass grafting. The route of protamine administration was
randomized in a balanced fashion between right atrium, left atrium, and
aorta. The preoperative and operative characteristics of the three groups
were similar. Hemodynamic measurements were recorded before cannulation,
after removal of the venous drainage catheter, and 1 minute, 5 minutes, and
10 minutes after protamine administration. Hypotension occurred in 11
patients with no significant difference among the three groups. The
hypotension was immediate in three patients in whom route of administration
was the aorta. The overall hemodynamic changes observed for the three
treatment groups were not significantly different. An analysis for type II
error indicated that it was unlikely that an important difference had been
missed. We conclude that the route of administration does not affect the
hemodynamic changes associated with protamine administration. We did not
observe a case of severe hemodynamic deterioration, so that we cannot
assess the effect of route of administration on the severity of an
anaphylactic reaction.
ARTICLES
Hemodynamics of protamine administration. Comparison of right atrial, left atrial, and aortic injections
Department of Surgery, Georgetown University Hospital, Washington, D.C. 20007.
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P. R. B. Evora, P. J. Pearson, and H. V. Schaff Protamine Induces Endothelium-Dependent Vasodilatation of the Pulmonary Artery Ann. Thorac. Surg., August 1, 1995; 60(2): 405 - 410. [Abstract] [Full Text]
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M. Friedman, R. G. Johnson, S. Y. Wang, H. B. Dai, R. L. Thurer, R. M. Weintraub, and F. W. Sellke Pulmonary microvascular responses to protamine and histamineEffects of cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1092 - 1099. [Abstract] [Full Text]
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C. Aren Review article : Heparin and protamine during cardiac surgery Perfusion, July 1, 1989; 4(3): 171 - 181. [PDF]
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