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Related Experiment Videos

Protamine-induced circulatory changes.

R W Frater, Y Oka, Y Hong

    The Journal of Thoracic and Cardiovascular Surgery
    |May 1, 1984
    PubMed
    Summary
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    Administering protamine via the right atrium, unlike the left, causes a drop in blood pressure due to histamine release. This study compares protamine administration routes in bypass graft patients.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Physiology

    Background:

    • Protamine administration is crucial after heparin reversal in cardiac surgery.
    • The route of protamine administration may influence hemodynamic effects and potential adverse reactions.

    Purpose of the Study:

    • To compare the hemodynamic effects and histamine release associated with protamine administration via the left versus the right atrium.
    • To investigate the safety and efficacy of different protamine administration routes.

    Main Methods:

    • Seventeen patients undergoing coronary artery bypass graft surgery were studied.
    • Protamine was administered either via the right atrium (nine patients) or the left atrium (eight patients).
    • Hemodynamic parameters (arterial pressure, atrial pressures, cardiac output) and plasma histamine levels were measured before and after administration.

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    Main Results:

    • Right atrial protamine administration led to a significant decrease in systolic blood pressure and systemic vascular resistance, with a transient increase in cardiac index.
    • Left atrial administration did not cause significant hemodynamic changes.
    • Plasma histamine levels were significantly higher after right atrial injection, suggesting histamine release during lung transit.

    Conclusions:

    • Histamine release, triggered by protamine traversing the lungs after right atrial injection, causes peripheral vasodilation.
    • The right atrial route for protamine administration is associated with greater hemodynamic effects and histamine release compared to the left atrial route.