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Canadian Journal of Anesthesia, Vol 31, 314-318, Copyright © 1984 by Canadian Anesthesiologists' Society

Clinical Reports: Cardiac Arrest Following Protamine Administration

FRANCES CHUNG MD FRCP(C)1 and JOHN MILES MD FRCS(C)1

1 Department of Anaesthesia and Surgery, University of Toronto and Toronto Western Hospital

Address correspondence to: Dr. F. Chung, Department of Anaesthesia, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, M5T 2S8.

A case report of fatal cardiac arrest following protamine reversal of systemic heparinization during vascular surgery is presented. Patients who have received protamine zinc insulin, NPH insulin, and those with previous exposure to protamine sulphate or allergy to fish are more likely to have a reaction to protamine. Protamine-induced hypotension can be mediated by immunological or non-immunological mechanisms. Several alternative methods of heparin reversal which may avoid similar catastrophes are presented.

Key Words: ANAPHYLAXIS: protamine • SURGERY: cardiovascular, peripheral vascular






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Copyright © 1984 by the Canadian Anesthesiologists' Society.