Effect of Lidocaine Pre-Treatment on Protamine-Induced Pulmonary Vascular Reaction During the Repair of Congenital Heart Disease

Abstract

Background Protamine is a polycationic, and a strong basic peptide isolated from Clupeidae or Salmonidae fishes’ sperm, which is rich in arginine and highly alkaline. Objective To explore the effect of lidocaine pre-treatment on protamine-induced pulmonary vascular reaction during the repair of congenital heart disease. Methods Eighty patients undergoing repair of congenital heart disease were randomly divided into four groups: A 1 (non-pulmonary hypertension + lidocaine pre-treatment) group, A 2 (non-pulmonary hypertension + normal saline) group, B 1 (pulmonary hypertension + lidocaine pre-treatment) group, and B 2 (pulmonary hypertension + normal saline) group. Hemodynamic parameters, pulmonary inflammation, and pulmonary function were assessed at six intraoperative time points, two intraoperative time points and three intraoperative time points, respectively. P -value <0.05 was considered statistically significant. Results A 2 group exhibited increased PAP, Paw, RI and A-aDO 2 . B 2 group exhibited increased Paw, RI and A-aDO 2 and decreased Cydn and OI after protamine administration. These changes were not observed in A 1 and B 1 group. Compared with A 1 and B 1 groups, plasma TXB 2 level in A 2 and B 2 group was higher, but 6-keto-PGF 1a in A 2 and B 2 groups was lower. Incidence of protamine adverse reactions in A 1 and B 1 group was lower than that in A 2 and B 2 group. Conclusion Precondition of lidocaine before neutralization of heparin may be effective for protamine-induced pulmonary vascular reaction during CHD repair.