PBSE Perfusion Practice Exam

Protamine reversal after CPB is known for causing hemodynamic instability, most notably hypotension, and in some patients an anaphylactic or anaphylactoid reaction. This reaction results from histamine release and can be more likely with rapid administration or prior protamine exposure. Because of this, hypotension with potential progression to shock (and sometimes bronchospasm) is the classic immediate risk described with protamine use. The other options—hypertension, hyperglycemia, and hyperkalemia—do not reflect the characteristic acute risks of protamine administration. To reduce risk, protamine should be given slowly with close monitoring, and be prepared to treat hypotension or anaphylaxis if they occur.