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I've routinely given pepcid and benadryl when starting a CABG, to guard against potential anaphylaxis to the protamine. While I've always done it for patients who are high risk (previous protamine exposure, s/p vasectomy, or on NPH insulin) I got in the habit of giving it to everyone, as do some of my colleages. Figured it couldn't hurt, and could possibly protect against someone who would be otherwise very sensitive (unknowingly) to the protamine. Besides, I'm not crazy about having to treat verrrrrrrrrry low BP after a reaction to the protamine.
While I don't do it in cases where the protamine dose will be much lower, such as AAA or carotid, I figured the high protamine dose given to a CABG patient is worth prophylaxing.
Yesterday I was chided for giving the pepcid and benadryl to a CABG patient who didn't have any of the usual pre-op red flags. When I replied that I gave it to everyone (for the above reasons) I was told, essentially, that I was wasting drugs and $$$$ and that no literature supported my practice.
Opinions please.
While I don't do it in cases where the protamine dose will be much lower, such as AAA or carotid, I figured the high protamine dose given to a CABG patient is worth prophylaxing.
Yesterday I was chided for giving the pepcid and benadryl to a CABG patient who didn't have any of the usual pre-op red flags. When I replied that I gave it to everyone (for the above reasons) I was told, essentially, that I was wasting drugs and $$$$ and that no literature supported my practice.
Opinions please.