Prophylactic administration of histamine1 and histamine2 receptor blockers in the prevention of protamine-related haemodynamic effects.

We studied the effects of the prophylactic administration of histamine1 and histamine2 receptor blockers on haemodynamic changes, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MBP), central venous pressure (CVP), and heart rate (HR, beats.min-1) before and after the administration of protamine in two groups of patients having coronary artery bypass graft surgery. Group I patients received no histamine blockers, whereas patients in Group II were treated prophylactically with both H1 (diphenhydramine) and H2 (cimetidine) receptor blockers. The mean SBP, DBP, MBP, CVP, and HR before (and after) administration of protamine in group I patients were 114 +/- 16 (90 +/- 16) mmHg, 64 +/- 11 (51 +/- 8) mmHg, 81 +/- 11 (65 +/- 10) mmHg, 10 +/- 3 (11 +/- 7) mmHg, and 92 +/- 10 (87 +/- 13) before (and after) protamine administration. Group II patients had mean SBP, DBP, MBP, CVP, and HR of 113 +/- 19 (113 +/- 17) mmHg, 61 +/- 12 (62 +/- 11) mmHg, 79 +/- 15 (80 +/- 13) mmHg, 9 +/- 3 (9 +/- 2) mmHg, and 88 +/- 6 (86 +/- 4) before (and after) protamine administration. Our data show that only in Group I patients who did not receive histamine receptor blockers, were there significant haemodynamic changes following protamine administration (P less than 0.05). We conclude that the prophylactic administration of histamine receptor blockers prevents some of the adverse haemodynamic effects associated with protamine administration.