ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -66 مورد

Adverse effects of protamine administration: Recognition and management

Adverse effects of protamine administration: Recognition and management
Vasodilation
Clinical manifestations: Acute, not severe, transient
Probable mechanisms: Vasodilation and/or connective tissue mast cell degranulation resulting in histamine release
Management: Administer vasopressors as necessary
Anaphylaxis
Clinical manifestations: Signs may include urticaria, wheezing and bronchospasm, or cardiovascular responses (eg, marked vasodilation with profound hypotension)
Probable mechanisms: Immediate hypersensitivity is IgE-mediated, causing mast cell and basophil activation with subsequent mediator release; IgG formation with complement and neutrophil activation and increased platelet activating factor
Management:
  • Stop protamine and administer epinephrine bolus(es) and infusion
  • For bronchospasm, treat with albuterol 4 to 8 puffs (or 2.5 mg albuterol in 2.5 mL saline nebulized for administration via the ETT)
  • For refractory vasodilatory hypotension that does not respond to epinephrine infusion, administer norepinephrine or vasopressin; also, methylene blue may be administered to treat refractory vasodilation
Acute (catastrophic) pulmonary vasoconstriction
Clinical manifestations:
  • Sudden marked increases in mean PAP and acute RV dilatation
  • Shock develops rapidly
Probable mechanisms:
  • Rare hypersensitivity reaction that is probably complement-mediated due to antiprotamine IgG antibody interaction and/or protamine-heparin complex development, with C5a-mediated thromboxane formation
  • Pulmonary vasoconstriction occurs due to generation of the anaphylotoxin C5a, activation and aggregation of neutrophils that sequester in the pulmonary vasculature, microcirculatory occlusion, and thromboxane release
Management:
  • Stop protamine and administer epinephrine bolus(es) and infusion
  • Administer inhaled pulmonary vasodilator agents if necessary
  • Patients with severe pulmonary vasoconstriction and RV failure and shock may require reinstitution of CPB in cardiac surgical settings
CPB: cardiopulmonary bypass; ETT: endotracheal tube; PAP: pulmonary artery pressure; RV: right ventricular.
Graphic 148278 Version 1.0