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Hemodynamic Changes after the Administration of Protamine

Received from the Department of Anesthesiology, State University Hospital, Downstatc Medical Center, Brooklyn, New York.

Abstract

Hemodynamic changes associated with the administration of protamine were studied in 30 dogs divided into three equal groups. Protamine (1 mg·kg^–1 ·min¹ for 4 min) was administered 10 min after 4 mg·hg¹ heparin was given via a left atrial (LA) line in group A, via a central vein in group B, and via a peripheral vein in group C. Protamine given through the central venous pressure (CVP) line resulted in an immediate and significant decrease in mean arterial pressure (MAP) to 60 ± 4.5 mm Hg (P < 0.025) from 72 ± 7 mm Hg immediately after the protamine and to 58 ± 5 mm Hg (P < 0.025) 5 min later and with an increase in cardiac index (CI) to 3.7 ± 0.3 L·min¹·m^–2 from 2.8 ± .25 L·min^–1·m^–2 immediately after the protamine (P < 0.005), followed by a decrease back to 2.7 ± 0.3L·min^–1·m^–2 5 min later. Mean arterial pressure and CI remained unchanged after administration of protamine via the peripheral vein or the left atrium. Systemic vascular resistance (SVR) decreased significantly only after administration of protamine via the CVP and was statistically unchanged when administered via the peripheral and LA line. Plasma histamine levels increased significantly after administration of protamine through the central line but remained unchanged after administration via a peripheral vein or the left atrium. We conclude that hemodynamic changes after protamine administration may be related to protamine-induced histamine release from the lung and are greatly influenced by the site of administration. The greatest hemodynamic effect occurred when protamine was administered via the right atrium and the least when administrated via the peripheral vein. This is probably due to the fact that protamine, when injected into the right atrium, forms protamine heparin complex, which goes to the lung to release histamine, whereas it becomes diluted before reaching the lung when injected into a peripheral vein or left atrium.

Key Words: BLOOD, COAGULATION—protamine

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999