Effect of lidocaine pre-treatment on protamine-induced pulmonary vascular reaction during the repair of congenital heart disease

Abstract

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: A1 (non-pulmonary hypertension + lidocaine pre-treatment) group, A2 (non-pulmonary hypertension + normal saline) group, B1 (pulmonary hypertension + lidocaine pre-treatment) group, and B2 (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: A2 group exhibited increased PAP, Paw, RI and A-aDO2. B2 group exhibited increased Paw, RI and A-aDO2 and decreased Cydn and OI after protamine administration. These changes were not observed in A1 and B1 group. Compared with A1 and B1 groups, plasma TXB2 level in A2 and B2 group was higher, but 6-keto-PGF1a in A2 and B2 groups was lower. Incidence of protamine adverse reactions in A1 and B1 group was lower than that in A2 and B2 group. Conclusion: Precondition of lidocaine before neutralization of heparin may be effective for protamine-induced pulmonary vascular reaction during CHD repair.