Home > Residency > PGY-2 (CA-1) > Protamine and Insulin – Two Dangerous Drugs

Protamine and Insulin – Two Dangerous Drugs

With nearly six months of anesthesia under my belt, I have a newfound respect for many of the drugs we administer intraoperatively… especially the potential dangers of insulin and protamine.

The threshold for treating hyperglycemia varies depending on the nature of the surgery, patient status, symptoms, and prior regimen; however, in the anesthetized patient, what symptoms can we monitor? I’ve seen regular insulin dispensed in concentrations of 10 units/cc and 100 units/cc. To this day, I check, recheck, and check the concentration all over again. Imagine giving ten-fold the dose you intended to an anesthetized patient. When his or her blood glucose falls to the 20s, and they happen to have muscle relaxant on board, how can you look for the “typical signs” of hypoglycemia (complaints of light-headedness, tremors, seizures, etc.) Their presenting symptom could easily be far more dangerous like cardiac asystole.

Protamine is routinely used to reverse the effects of heparin in vascular and cardiothoracic surgeries. It has well known side effects ranging from transient hypotension and anaphylaxis to catastrophic pulmonary hypertension. Aside from the side effects, the timing of protamine is extremely important. If given too early, you can throw a patient on cardiopulmonary bypass into full blown extracorporeal clotting or destroy the viability of a vessel graft. Coordinating the dose and timing of protamine with the surgeon is essential! Remember to give it slowly too!

 LEGAL

My posts are not to serve as a replacement for recommendations provided by licensed physicians nor do they represent the opinions of Baylor College of Medicine or its affiliated institutions. Please read this site's Disclaimer and Terms of Use for more information.

ALSO CHECK OUT  

First Year Of Anesthesiology Residency (CA-1) In Retrospect

Today marks the end of my first year of clinical anesthesia (CA-1) and wanted to reflect …

 DROP A LINE

Your email address will not be published. Required fields are marked *