The adequacy of anticoagulation with heparin during cardiopulmonary bypass, and precise neutralization with protamine at the conclusion of cardiopulmonary bypass, were important. In sixty children undergoing cardiopulmonary bypass, ACT and heparin dose-respones curve were studied. Total dose of heparin before bypass were 2.800.74 mg /kg and the amount of protamine administered after bypass were 3.01.23 mg /kg. So protamine heparin ratio was 1.07 : 1.
After administration of protamine which dose is calculated with heparin dose-response curve, ACTs were returned to normal range(mean 114.8 13 second). The heparin sensitivity and its half-life do not have relationship with age, weight, height, surface area and urin amount during operation. And there are too much individual variations in heparin sensitivity and its half-life. So conventional heparin protocols can overestimate or understimate th amount of heparin and protamine. Heparin dose-response curve makes it possible to maintain anticoagulation in a safe range during bypass with adequate amount of heparin individually. At the conclusion of bypass, this curve can be used to predict the precise amount of protamine amount of protamine needed for neutralization of the heparin. But heparin dose-response curve to be used clinically, further studies will be needed about relationship between ACT and heparin level in the high range, influence of hemodilution and hypothermia to ACT and discrepancy between true adequate amount of protamine and calculated amount by heparin dose-response curve.
|