Protamine in CABG

[Monty Python]

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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.

 

[jetproppilot]

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.

Trinity,

We also used to prophylax everyone (OH WAIT A MINUTE...WE WERE IN THE SAME GROUP TIL I LEFT A YEAR AGO!! ) which I thought was overkill.
I agree with whoever finally said its overkill to prophylax everyone.

 

[militarymd]

zero lit for prophylasis to everyone.....

I'll bet that if YOU had to pay for treatments that had no data to support...or no practice guidelines to support......You would not be giving that treatment.

 

[jetproppilot]

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.

Plus benadryl with its long half life contributes unneedingly to post op sedation which could potentially prolong time to extubation.

 

[cchoukal]

don't pepcid and benadryl cost, like, pennies?

 

[jetproppilot]

don't pepcid and benadryl cost, like, pennies?

a patient in the hospital is billed like 17 bucks for a fuc@ing aspirin. Its not how much it costs at Eckerds, its what the hospitals bill the patients that counts.

And even if it costs a nickel, if there is no literature to support its efficacy, why would you give it?