[Anaphylactic reaction to protamine in cardiovascular surgery]

The authors describe a serious anaphylactic reaction after protamine administration and its successful control. In cardiovascular surgery protamine a basic peptide, is used as a matter of routine to eliminate the anticoagulation effect of heparin. The use of this drug is associated with a number of negative haemodynamic reactions, most of them not serious, the incidence of which varies from 0 to 100%. The incidence of serious reactions associated with a life threatening drop of the blood pressure is reported to be between 0.13% to 4%, depending whether a retrospective or prospective study is involved. The pathogenesis of this anaphylactic reaction is not quite clear. Prevention in patients with known risk factors is problematic. Treatment of the allergic reaction to protamine is still symptomatic. In the authors' patient the condition was coped with by administration of colloid solutions, adrenaline and solumedrol.