Effect of Lidocaine Pre-Treatment on Protamine-Induced Pulmonary Vascular Reaction During the Repair of Congenital Heart Disease

BACKGROUND: Protamine is a polycationic, and a strong basic peptide isolated from Clupeidae or Salmonidae fishes’ sperm, which is rich in arginine and highly alkaline. OBJECTIVE: To explore the effect of lidocaine pre-treatment on protamine-induced pulmonary vascular reaction during the repair of congenital heart disease. METHODS: Eighty patients undergoing repair of congenital heart disease were randomly divided into four groups: A(1) (non-pulmonary hypertension + lidocaine pre-treatment) group, A(2) (non-pulmonary hypertension + normal saline) group, B(1) (pulmonary hypertension + lidocaine pre-treatment) group, and B(2) (pulmonary hypertension + normal saline) group. Hemodynamic parameters, pulmonary inflammation, and pulmonary function were assessed at six intraoperative time points, two intraoperative time points and three intraoperative time points, respectively. P-value <0.05 was considered statistically significant. RESULTS: A(2) group exhibited increased PAP, Paw, RI and A-aDO(2). B(2) group exhibited increased Paw, RI and A-aDO(2) and decreased Cydn and OI after protamine administration. These changes were not observed in A(1) and B(1) group. Compared with A(1) and B(1) groups, plasma TXB(2) level in A(2) and B(2) group was higher, but 6-keto-PGF(1a) in A(2) and B(2) groups was lower. Incidence of protamine adverse reactions in A(1) and B(1) group was lower than that in A(2) and B(2) group. CONCLUSION: Precondition of lidocaine before neutralization of heparin may be effective for protamine-induced pulmonary vascular reaction during CHD repair.