Use of Nitric Oxide for Treatment of Pulmonary Hypertensive Crisis in a Child After Protamine Administration

Abstract

PROTAMINE ADMINISTRATION may cause systemic hypotension, pulmonary hypertension, anaphylactic shock, and cardiovascular collapse. 1 Horrow J.C. Protamine: A review of its toxicity. Anesth Analg. 1985; 64: 348-361 Crossref PubMed Google Scholar , 2 Carr J.A. Silverman N. The heparin-protamine interaction A review. J Cardiovasc Surg. 1999; 40: 659-666 PubMed Google Scholar These adverse reactions are more commonly reported in adults than in children. In one recent pediatric study, 3 Seifert H.A. Jobes D.R. Ten Have T. et al. Adverse events after protamine administration following cardiopulmonary bypass in infants and children. Anesth Analg. 2003; 97: 383-389 Crossref PubMed Scopus (35) Google Scholar the only adverse reaction noted was systemic hypotension. Because severe pulmonary hypertension has rarely been noted in children after heparin reversal, the authors report a pulmonary hypertensive crisis in a child after protamine administration, which was successfully treated with nitric oxide (NO).