Canadian Journal of Anaesthesia

, Volume 37, Issue 4, pp 420–422

Prophylactic administration of histamine1 and histamine2 receptor blockers in the prevention of protamine-related haemodynamic effects

Authors

  • Jay Kambam
    • Department of AnaesthesiologyVanderbilt University School of Medicine
  • Rozalia Meszaros
    • Hungarian Institute of Cardiology
  • Walter Merrill
    • Department of Thoracic and Cardiac SurgeryVanderbilt University School of Medicine
  • James Stewart
    • Department of Thoracic and Cardiac SurgeryVanderbilt University School of Medicine
  • Bradley E. Smith
    • Department of AnaesthesiologyVanderbilt University School of Medicine
  • Harvey Bender
    • Department of Thoracic and Cardiac SurgeryVanderbilt University School of Medicine
Reports of Investigation

DOI: 10.1007/BF03005618

Cite this article as:
Kambam, J., Meszaros, R., Merrill, W. et al. Can J Anaesth (1990) 37: 420. doi:10.1007/BF03005618

Abstract

We studied the effects of the prophylactic administration of histamine1 and histamine2 receptor blockers on haemodynamic changes, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MBP), central venous pressure (CVP), and heart rate (HR, beats · min−1) before and after the administration of protamine in two groups of patients having coronary artery bypass graft surgery. Group I patients received no histamine blockers, whereas patients in Group II were treated prophylactically with both H1 (diphenhydramine) and H2 (cimetidine) receptor blockers. The mean SBP, DBP, MBP, CVP, and HR before (and after) administration of protamine in group I patients were 114 ± 16 (90 ± 16) mmHg, 64 ± 11 (51 ± 8) mmHg, 81 ± 11 (65 ± 10) mmHg, 10 ± 3 (11 ± 7) mmHg, and 92 ± 10(87 ± 13) before (and after) protamine administration. Group II patients had mean SBP, DBP, MBP, CVP, and HR of 113 ± 19 (113 ± 17) mmHg, 61 ± 12 (62 ± 11) mmHg, 79 ± 15 (80 ± 13) mmHg, 9 ± 3(9 ± 2) mmHg, and 88 ± 6 (86 ± 4) before (and after) protamine administration. Our data show that only in Group I patients who did not receive histamine receptor blockers, were there significant haemodynamic changes following protamine administration (P < 0.05). We conclude that the prophylactic administration of histamine receptor blockers prevents some of the adverse haemodynamic effects associated with protamine administration.

Key words

allergy: protamineblood: coagulation, protaminehistamine: antagonists, cimetidine, diphenhydramine

Résumé

Avec le concours de candidats à une revascularisation coronarienne, nous avons mesuré l’effet de l’utilisation de bloqueurs des récepteurs histaminiques H1 et H2 avant l’injection de protamine, sur la réponse hemodynamique à cette dernière. Les patients du Groupe I ne recevaient aucun pré-traitement mais nous injections prophylactiquement de la dyphenhydramine (anti-H1) et de la cimétidine (anti-H2) à ceux du Groupe II. Les moyennes des pressions artérielles systoliques, diastoliques, des tensions veineuses centrales et du pouls avant (et après) l’injection de protamine étaient respectivement dans le Groupe I de: 114 ± 16 (90 ± 16), 64 ± 11 (51 ± 8), 81 ± 11 (65 ± 10), 10 ± 3 (11 ± 7) mmHg et de 92 ± 10 (87 ± 13) battements · min−1. Dans le Groupe II, ces mêmes moyennes étaient de: 113 ± 19 (113 ± 17), 61 ± 12 (61 ± 11), 79 ± 15 (80 ± 13), 9 ± 3 (9 ± 2) mmHg et de 88 ± 6 (86 ± 4) battements min−1. La protamine n’a entraîné de changements hémodynamiques significatifs (P <0,05) que chez les patients du Groupe I, ceux qui n’avaient pas reçu de pré-traitement. Il semble done que l’injection prophylactique de bloqueurs des récepteurs histaminiques puisse prévenir certains des effets hémodynamiques de l’injection de protamine.

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© Canadian Anesthesiologists 1990