POSTER PRESENTATIONS Poster Session 1 Wednesday, June 24, 2015 1:00 p.m.–2:00 p.m., Poster Exhibition Area P-01 Individualized protamine dosing based on a computerized pharmacokinetic model M.I. Meesters 1 , D. Veerhoek 2 , J.R. de Jong 1 , G. Kuiper 1 , C. Boer 1 Department of 1 Anesthesiology and 2 Cardio-thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center Introduction. Protamine has intrinsic anticoagulant properties and protamine dosing based on a fixed dosing ratio to heparin might overdose protamine impairing patient hemostasis. This study compared hemostasis of fixed ratio protamine dosing to protamine dosing based on a novel computerized pharmacoki- netic (PK) model of heparin. Methods. This case-control study included 109 patients under- going elective cardiac surgery with CPB. In 56 patients prota- mine was dosed in a fixed ratio, while 63 patients received protamine based on the PK-model. Study parameters included delta activated clotting time (ΔACT ¼ ACT after protamine minus preoperative ACT), aPTT, rotational thromboelastometry (INTEM and HEPTEM), blood loss and blood transfusion. Data was analysed by Student’s T-test or Mann Witney test. Results. There was no difference in the amount of heparin administrated (414  107 mg (fixed ratio group) vs. 403  90 mg (PK-group); n.s.), whereas protamine dosing was considerably different with a protamine:heparin-ratio of 1.1  0.3 for the fixed dosing ratio and 0.5  0.1 for the PK-group, po0.001. The ΔACT values were not different (þ17  77 s for the fixed ratio group and þ6  15 s for the PK-dosed group). Postoperative aPTT values were similar (42  13 s vs. 43  5 s; n.s.). Thromboelastometric data were prolonged in the routine prac- tice group compared to the PK group, INTEM clotting time (CT) 250  76 s vs. 198  32 s and HEPTEM CT 275  105 vs. 198  32 s (both Po0.001). Median packed red blood cell transfusion ((0 (0-2) vs. 0(0-0)), fresh frozen plasma transfusion ((1 (0-2) vs. 0 (0-0)) and platelet concentrate transfusion (0 (0-1) vs. 0 (0-0)) were different between the fixed ratio and PK group, respectively (all Po0.001). Although postoperative hemostasis differed 24-hour postoperative blood loss did not differ between the fixed ratio and PK group, (389 (293-548) ml vs. 340 (243-525) ml; n.s.). Conclusion. Patient-tailored protamine dosing based on a phar- macokinetic model resulted in a significant reduction of protamine dosing with better hemostasis and fewer blood product transfu- sion when compared to fixed ratio protamine dosing. P-02 Anesthetic management of a matient with might mentricular mpicardium mocated cyst hydatid Ömer Faruk Boran, Aykut Urfalıoğlu, Mahmut Arslan, Gökçe Gişi, Bora Bilal, Hüseyin Yıldız, Hafize Öksüz Kahramanmaraş Sütçü İmam Üniversity Introduction. Cardiac echinococcosis is rare and medical treat- ment may be insufficient to prevent fatal complications. We aimed to share our perioperative management in a cardiac echinococcosis case. Case. In transthoracic echocardiography and magnetic reso- nance examination of 14 years old and 48 kg in weight female patient; who admitted to the pediatric cardiology clinic with complaints of fainting, palpitations and fatigue, 88*75 mm axial size cystic lesion that is in continuity with heart muscle in right ventricular was detected. Considered at ASA II risk group the patient was premedicated with iv midazolam, chlorphenoxamine, ranitidine, metoclopramide and methylprednisolone. After pre- oxygenation with 100 % O2, anesthesia was induced with propofol 2mg/kg, fentanyl 3 mcg/kg and rocuronium 0.6 mg/ kg. The patient was intubated at the first attempt and a right internal jugular vein catheter was inserted under ultrasound- guided. After the Allen test, radial artery was cannulated. After median sternotomy and establishing aortobicaval cannulation and cardiopulmonary bypass, cross-clamping was applied. After perfusion started, the heart was arrested with cardioplegia. Then, cyst was entered with a transverse incision and the contents of the cyst were aspirated and washed with hypertonic saline simultaneously and germinative membrane was removed. Right ventricular epicardium was closed and cross clamp was removed. For postoperative analgesia 0,1 mg/kg morphine was given. After 22 hours, the patient was extubated and she was discharged on the postoperative 5th day. Discussion. Cardiac cyst hydatid is an emergency situation that must be diagnosed and treated as soon as possible. The opening of the cyst in heart chambers and the pericardium may lead to fatal complications. Cyst fluid has highly antigenic properties and with the spread during the surgery, it can cause complications ranging from a benign urticaria to anaphylaxis. (1-2) The implementation of H1 and H2 receptor blockers in advance is recommended to minimize the changes due release of the cyst contents into circulation during the operation. The benzodiazepine and corticosteroids may also be helpful in preventing the effects related to histamine release (3). REFERENCES 1. Yüceyar L, Demirok M, Özdilmaç İ, Beşirli K, Aykaç B. Akciğer kist hidatiği nedeni ile torakotomi uygulanan hastada anaflaksi. Solunum 5:235-238, 2004 2. Vaquerizo A, Sola JL, Bondia A, Opla JM, Madariaga MJ. Intraoperative hydatid anaphylactic shock. Rev Esp Anestesiol Reanim 41(2):113-116, 1994 3. Kambam JR, Dymond R, Krestow M, Handte RE. Efficacy of histamine H1 and H2 receptor blockers in the anesthetic management during operation for hydatid cysts of liver and lungs. South Med J 81(8):1013, 1988 P-03 Intracoronary administration of levosimendan in acute cor- onary syndrome with decreased left ventricular ejection fraction: a case series Vjera Marinov, Nenad Karanovic, Mladen Carev, Dubravka Kocen, Mihajlo Lojpur, Zdenko Covic University Hospital Center Split Introduction. In patients (pts) undergoing cardiac surgery, intra- coronary (IC) administration of levosimendan can provide optimal regional distribution, enabling favourable effects (cardioprotective and positive inotropic), and avoiding potentially harmful systemic Journal of Cardiothoracic and Vascular Anesthesia, Vol 29, No S2 (June), 2015: pp S59–S80 S59