JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hines, R. L. Articles by Barash, P. G. Search for Related Content PubMed PubMed Citation Articles by Hines, R. L. Articles by Barash, P. G.

Protamine

Does It Alter Right Ventricular Function?

Received from the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.

Abstract

Protamine administration has been associated with cardiac decompensation secondary to acute pulmonary vasocon-striction and subsequent right ventricular failure. To determine whether protamine infusion produced alterations in right ventricular performance, we evaluated both right and left ventricular function in patients receiving protamine infusion. The dose of protamine administered was calculated as adequate to reverse heparin as measured by the activated clotting time (ACT). Indices of right and left ventricular function obtained included right atrial pressure, right ventricular pressure, right ventricular ejection fraction, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, blood pressure, and heart rate. These measurements were obtained prior to protamine administration, at 1/2 total protamine dose, at completion of protamine infusion, and prior to sternal closure. No significant changes in right ventricular ejection fraction, right ventricular end-diastolic pressure, mean pulmonary artery pressure, or pulmonary vascular resistance were seen at any point during the study. Left ventricular function remained unchanged. Even in patients who are possibly at an increased risk (pulmonary artery hypertension, PAP > 25 mm Hg), no deterioration in right or left ventricular function could be demonstrated following protamine administration. These data suggest that protamine does not consistently exert a significant detrimental effect on right ventricular performance.

Key Words: BLOOD, COAGULATION—protamine. • HEART—ventricular function. • LUNGS—vasculature.

This article has been cited by other articles:

				J. H. Levy and N. F. Adkinson Jr Anaphylaxis During Cardiac Surgery: Implications for Clinicians Anesth. Analg., February 1, 2008; 106(2): 392 - 403. [Abstract] [Full Text] [PDF]

				F. Viaro, M. B. Dalio, and P. R. B. Evora MD Catastrophic Cardiovascular Adverse Reactions to Protamine Are Nitric Oxide/Cyclic Guanosine Monophosphate Dependent and Endothelium Mediated* : Should Methylene Blue Be the Treatment of Choice? Chest, September 1, 2002; 122(3): 1061 - 1066. [Abstract] [Full Text] [PDF]

				A. Belboul and N. Al-Khaja The effect of protamine on the epicardial microflow and the graft flow in open-heart surgery Perfusion, March 1, 1997; 12(2): 99 - 106. [Abstract] [PDF]

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