Haemodynamic changes and circulating histamine concentrations following protamine administration to patients and dogs

Abstract

Haemodynamic

The Effect of Differing Rates and Injection Sites on the Amount of Protamine Delivered Before Detection of Hemodynamic Alterations in Dogs

“…In this study, the rate of protamine administration did not have a significant effect on the amount of protamine delivered before a reaction occurred; however, there were significantly fewer protamine reactions in the CS group compared with all other groups. In 1 study in dogs, adverse protamine reactions did not occur when protamine was delivered over 5 minutes compared with an intravenous bolus 40 . This contrasts with our study in which significant protamine reactions occurred in both the fast group (10 mg/min) and the slow group (5 mg/min).…”

“…In 1 study in dogs, adverse protamine reactions did not occur when protamine was delivered over 5 minutes compared with an intravenous bolus. 40 This contrasts with our study in which significant protamine reactions occurred in both the fast group (10 mg/min) and the slow group (5 mg/min). An important difference of this study compared with the study by Stoelting et al 40 is that the dogs in the latter study were not heparinized before protamine administration.…”

Open heart surgery increases the levels of histamine in arterial and coronary sinus blood

“…Patients given H1-and H2-receptor blockers prior to protamine administration suffered less adverse hemodynamic effects than patients without histamine blockers [38]. Plasma histamine increases induced by protamine may depend both on the route and speed of drug administration [39,40]. We did not find increased histamine levels 5 min after protamine infusion.…”

Histamine in Anaesthesia and Surgery: Causality Analysis

“…12). The situation with protamine is less clear than with heparin since a variety of mechanisms have been proposed for even the fatal reactions to protamine: complement activation, kallikrein-kinin system activation, formation of thromboxane A2 , anaphylactic response due to specific IgE antibodies and non-immunological histamine release (STOELTING et al 1984;WESTABY et al 1985;HORROW 1985a,b;SHARATH et al 1985;COLMAN 1987;MOREL et al 1987). The main problem again seems to be interpretation of the data.…”

“…If histamine release is only a contributory determinant in protamine reactions then the analysis of individual cases and the calculation of conditional probabilities [P (AR HR) > P(AR HR)] is necessary. This has been performed by individual analysis in the article of MOREL et al (1987), but not in that of STOELTING et al (1984). Individual case analysis favours histamine release as an important chemical factor in patients with considerably peripheral vasodilatation, but not with acute pulmonal hypertension (MOREL et al 1987).…”