Operation with Cardiopulmonary Bypass Using Heparin and Nafamostat Mesilate for a Patient with Protamine Allergy

(Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan)

Hideki Morita Hideo Yoshida Teiji Jinno
Mamoru Tago Masataka Yamane
A 77-year-old woman was given general anesthesia for an ascending aortic aneurysm operation and went into anaphylactic shock. The operation was canceled. Vecuronium, pancuronium, protamine and famotidine revealed positive prick test reactions. Ascending aortic replacement underwent under minimum dose of heparin for cardiopulmonary bypass (CPB). Heparin was injected immediately before CPB (2.5mg/kg) and nafamostat mesilate was injected continuously during CPB (2mg/kg/h). The ACT value was over 1,400sec during CPB. However, protamine was not used after CPB. The operation time was 4h and 30min. CPB time was 1h and 26min. After the patient returned to the ICU, bleeding from the chest drainage tubes increased temporarily. The bleeding decreased gradually after administration of FFP and MAP.
@Jpn. J. Cardiovasc. Surg. 33: 140-142 (2004)