[Anaphylaxis to protamine during cardiovascular surgery].
Protamine is a polypeptide with low molecular weights that is used widely to reverse heparin anticoagulation during cardiac surgery. Protamine, efficient and relatively sure, can produce multiple adverse reactions after intravenous administration, including pulmonary hypertension, or systemic hypotension leading at times to cardiovascular collapse and death. Physiopathologic mechanisms, underlying these reactions, are not clear. Immunologic and non-immunologic pathways are suggested. Some risk factors expose to protamine's adverse reactions. Preoperative identification of these factors should prompt specific preventive measures. The anesthesiologist and the cardiac surgeon must be vigilant when administrating protamine. Reheparinization and reinstitution of cardiopulmonary bypass should be considered in patients with refractory shock.
Service d'anesthésie réanimation, CHU Mohammed VI, Oujda, Maroc.
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H
Madani
Service de chirurgie cardiovasculaire, CHU Hassan II, Fès, Maroc.
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EO
Sadiki
Service de chirurgie cardiovasculaire, CHU Hassan II, Fès, Maroc.
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M
Bouziane
Service de chirurgie cardiovasculaire, CHU Hassan II, Fès, Maroc.
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S
Amaarouch
Service de chirurgie cardiovasculaire, CHU Hassan II, Fès, Maroc. Electronic address: madanimouhcine@hotmail.com.
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M
Madani
Service d'anesthésie réanimation A1, CHU Hassan II, Fès, Maroc.
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M
Khatouf
D000707:Anaphylaxis / Q000209:etiology / Q000628:therapy*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000628:therapy*; D006494:Heparin Antagonists / Q000009:adverse effects*; D006801:Humans; D011479:Protamines / Q000009:adverse effects*; D012307:Risk Factors
D006494:Heparin Antagonists; D011479:Protamines
Allergie; Anaphylaxis; Cardiopulmonary bypass; Cardiovascular surgery; Chirurgie cardiovasculaire; Circulation extracorporelle; Heparin; Héparine; Protamine