Abstract
Two case reports are described of acute anaphylactoid reactions following the administration of protamine to reverse the anticoagulation effect of heparin in patients undergoing coronary artery bypass graft surgery. The administration of cimetidine seemed to reverse the anaphylactoid reaction after conventional treatment with epinephrine, H1 receptor blocker, and steroids had failed. We recommend that H2 receptor blockade be included with other drugs in the treatment of anaphylactoid reactions following protamine, and possibly after anaphylactoid reactions associated with other substances.
Résumé
En chirurgie cardiovasculaire on utilise souvent de la protamine, un composé polycationique alcalin, en tant qu’ antidote à l’ anticoagulation de l’ héparine. L’ usage de la protamine peut causer diverses réactions telles que: hypotension légère, vasoconstriction pulmonaire marquée, hypoxémie et choc anaphylactoïde.1–4D’aucuns croient que ces complications peuvent être expliquées par la libération d’histamine par des mastocytes mis en contact avec la protamine. Transmetteur par excellence des réactions allergiques, l’ histamine agit sur deux types de récepteurs, H1 et H2. Certains des effets hémodynamiques de l’ histamine peuvent être contrés par des antagonistes des récepteurs H1, mais le rôle des anti-H2 dans le traitement des reactions anaphylactoïdes n’a pas encore été établi. Avec la protamine, deux de nos patients ont eu une réaction anaphylactoide résistante à la thérapie suivante: hydratation intraveineuse, adrénaline, diphenhydramine, chlorure de calcium et stéroïdes. Nous avons alors injecté de la cimétidine, un anti-H2, qui a rapidement corrigé le problème.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Moorthy SS, Pond W, Rowland RG. Severe circulatory shock following protamine. Anesth Analg 1980; 59: 77–8.
Conahan TJ III,Andrews RW, MacVaugh H. Cardiovascular effects of protamine sulfate in man. Anesth Analg 1981; 60: 33–6.
Shapira N, Schaff H, Piehler JM et al. Cardiovascular effects of protamine sulfate in man. J Thorac Cardiovasc Surg 1982; 85: 505–14.
Michaels I, Barash P. Hemodynamic changes during protamine administration. Anesth Analg 1983; 62: 831–5.
Casthely PA, Goodman K, Fyman PN, Abrams LM, Aaron D. Hemodynamic changes after the administration of protamine. Anesth Analg 1986; 65: 78–80.
Levy J, Saiden J, Faraj B. Prospective evaluation of risk of protamine reactions in patients with NPH insulindependent diabetes. Anesth Analg 1986; 65: 739–42.
Knape J et al. An anaphylactic reaction to protamine in a patient allergic to fish. Anesthesiology 1981; 55: 32–4.
Hellema HWT, Rumke P. Serum auto antibodies as a consequence of vasectomy. Clin Exp Immunol 1978; 31: 18–29.
Lowenstein E et al. Catastrophic pulmonary vasoconstriction associated with protamine reversal of heparin. Anesthesiology 1983; 59: 470–3.
Kim YD, Michalik R, Lees DE, Jones M, Hanowell S, Macnamara TE. Protamine induced arterial hypoxaemia: the relationship to hypoxic pulmonary vasoconstriction. Can Anaesth Soc J 1985; 32: 5–11.
Wakefield TW, Whitehouse WM Jr, Stanley JC. Depressed cardiovascular function and altered platelet kinetics following protamine sulfate reversal of heparin activity. J Vasc Surg 1984; 1: 346–55.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kambam, J.R., Merrill, W.H. & Smith, B.E. Histamine2 receptor blocker in the treatment of protamine related anaphylactoid reactions: two case reports. Can J Anaesth 36, 463–465 (1989). https://doi.org/10.1007/BF03005349
Issue Date:
DOI: https://doi.org/10.1007/BF03005349