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

  • Jay Kambam
  • Rozalia Meszaros
  • Walter Merrill
  • James Stewart
  • Bradley E. Smith
  • Harvey Bender
Reports of Investigation

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: protamine blood: coagulation, protamine histamine: 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.

References

  1. 1.
    Moorthy SS, Pond W, Rowland RG. Severe circulatory shock following protamine. Anesth Analg 1980; 59: 77–8.PubMedGoogle Scholar
  2. 2.
    Conahan TJ III, Andrews RW, MacVaugh H. Cardiovascular effects of protamine sulfate in man. Anesth Analg 1981; 60: 33–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Shapiro N, Schaff H, Piehler JM, et al. Cardiovascular effects of protamine sulfate in man. J Thorac Cardiovasc Surg 1982; 86: 505–14.Google Scholar
  4. 4.
    Lieberman P, Siegle RL, Taylor WW. Anaphylactoid reactions to iodinated contrast material. J Allergy Clin Immunol 1978; 62: 174–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Philbin DM, Moss J, Akins CW et al. The use of H1 and H2 histamine antagonists with morphine anesthesia: a double-blind study. Anesthesiology 1981; 55: 292–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Scott RPF, Savarese JJ, Basta SJ Atracurium: clinical strategies for preventing histamine release and attenuating the hemodynamic response. Br J Anaesth 1985; 57: 550–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Kelly JF, Patterson R. Anaphylaxis: course, mechanisms, and treatment. JAMA 1974; 227: 1431–6.Google Scholar
  8. 8.
    Watkins J. Anaphylactoid reactions to IV substances. Br J Anaesth 1979; 51: 51–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Pierre A, Goodman K, Fyman P et al. Hemodynamic changes after the administration of protamine. Anesth Analg 1986; 65: 78–80.Google Scholar
  10. 10.
    Horrow JC. Protamine: a review of its toxicity. Anesth Analg 1985; 64: 348–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Frater RWM, Oka Y, Hong Y, Tsubo T, Loubser PG, Masone R. Protamine-induced circulatory changes. J Thorac Cardiovasc Surg 1984; 87: 687–92.PubMedGoogle Scholar
  12. 12.
    Goldman BS, Joison J, Austen WG. Cardiovascular effects of protamine sulfate. Ann Thor Surg 1969; 7: 459–71.Google Scholar
  13. 13.
    Levy J, Zaidan J, Faraj B. Prospective evaluation of risk of protamine reactions in patients with NPH insulin-dependent diabetes. Anesth Analg 1986; 65: 739–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Knape J, Schuller J, de Haan P et al. An anaphylactic reaction to protamine in a patient allergic to fish. Anesthesiology 1981; 55: 324–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Lowenstein E, Johnston WE, Lappas DG et al. Catastrophic pulmonary vasoconstriction associated with protamine reversal of heparin. Anesthesiology 1983; 59: 470–316.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim YD, Michalik R, Lees DE et al. Protamine induced arterial hypoxemia: the relationship to hypoxic pulmonary vasoconstriction. Can Anaesth Soc J 1985; 32: 5–11.PubMedCrossRefGoogle Scholar
  17. 17.
    Olinger GN, Becker RM, Bonchek LI. Noncardiac pulmonary edema and peripheral vascular collapse following cardiopulmonary bypass: rare protamine reaction? Ann Thor Surg 1980; 29: 20–5.Google Scholar
  18. 18.
    Radegran K, McAshlan C. Circulatory and ventilatory effects of induced platelet aggregation and their inhibition by acetylsalicylic acid. Acta Anaesthesiol Scand 1972; 16: 76–84.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1990

Authors and Affiliations

  • Jay Kambam
    • 1
  • Rozalia Meszaros
    • 3
  • Walter Merrill
    • 2
  • James Stewart
    • 2
  • Bradley E. Smith
    • 1
  • Harvey Bender
    • 2
  1. 1.Department of AnaesthesiologyVanderbilt University School of MedicineNashville
  2. 2.Department of Thoracic and Cardiac SurgeryVanderbilt University School of MedicineNashville
  3. 3.Hungarian Institute of CardiologyBudapestHungary

Personalised recommendations