Intramyometrial vasopressin: A fear for anesthetist?

Kabade, Savitri D; Sachidananda, Roopa; Wilson, Elizabeth; Divater, Shobha B

doi:10.4103/sja.sja_102_17

Cited by 3 publications

(4 citation statements)

References 6 publications

(8 reference statements)

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“…Kabade et al . [ 26 ] reported a case of bradycardia, severe hypotension, cardiac arrest after intramyometrial vasopressin (8 units, 0.2 unit/ml). After resuscitation, the patient recovered, but the haemodynamics was severely unstable even with inotropic support, and the echocardiography showed severe deterioration in the ejection fraction compared to the preoperative echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy

Soliman

Yacoub

Elbiaa

2021

Indian Journal of Anaesthesia

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Background and Aims: Myomectomy is associated with perioperative bleeding. The aim of the study is to evaluate the effect of intramyometrial vasopressin on blood loss and the associated cardiovascular complications during myomectomy. Methods: The study included 194 patients classified into two groups- 1) Vasopressin group: the vasopressin was diluted as 0.1 unit/ml and 15 ml was injected by the surgeon in the plane between the myometrium and the myoma. 2) Control group: The patients received an equal amount of normal saline. The monitored parameters included the amount of blood loss, required blood transfusion, heart rate, mean arterial blood pressure, the incidence of hypertension, hypotension, bradycardia, tachycardia, electrocardiogram (ECG) changes and the blood troponin I level. Results: The heart rate decreased significantly in both groups, but the decrease was lower with vasopressin than the control group through the time points T3 to T5 ( P < 0.05) The mean arterial blood pressure increased significantly in both groups, but the increase was higher with vasopressin than the control group through T3 to T5 ( P < 0.05). The amount of blood loss decreased significantly with vasopressin than the control groups ( P = 0.001). The number of transfused packed red blood cells was lower with vasopressin than the control group ( P = 0.001). The incidence of hypertension, bradycardia and atrial extrasystole was higher with vasopressin than the control group ( P = 0.005, P = 0.012, P = 0.033, respectively). Conclusion: Intramyometrial vasopressin decreases blood loss and blood transfusion, but it is associated with cardiovascular complications that may be serious as reported in other studies. Therefore, anaesthesiologists and gynaecologists must follow the precautions to avoid and minimise the incidence of complications with intramyometrial vasopressin.

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Section: Discussionmentioning

confidence: 99%

Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy

Soliman

Yacoub

Elbiaa

2021

Indian Journal of Anaesthesia

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“…The patient had severe bradycardia, hypotension, pulmonary edema, cardiac failure, and death. 4 Bradycardia and atrioventricular block with bigeminni was reported after injection of 3 units diluted vasopressin in the fibroid. 5 A cumulative total dose of 4-6 units of vasopressin in a dilute solution to be a reasonable upper limit.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Tachycardia Caused by Intramyometrial Infiltration of Vasopressin during Laparoscopic Myomectomy: An Anesthesiologist's Nightmare

Godbole¹

2019

The Journal of Medical Sciences

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All endoscopic procedures demand minimal blood loss during surgery to achieve good visibility which facilitates the speed of surgery. Vasopressin is often used for local infiltration during uterine myomectomy. It has good clinical effects but its systemic absorption may pose significant challenges for the anesthesiologist. It may sometimes lead to lethal complications. The loss of peripheral pulse along with bradycardia, nonmeasurable blood pressure, and cardiac complications have been reported after intramyometrial injection of vasopressin. Here, we describe a patient with multiple uterine fibroids who developed ventricular tachycardia within 2-3 minutes after intramyometrial infiltration of vasopressin diluted in normal saline. The total dose of vasopressin being 5.36 units (0.067 units/mL) with severe peripheral arterial vasospasm, increased blood pressure, and ventricular tachycardia followed by pulmonary edema. The patient was successfully resuscitated.

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“…However, their effects may not be completely controlled and may have negative results. Vasopressin, for example, has a short half‐life of 10–20 min, and its use has led to rare but serious consequences such as bradycardia, cardiovascular collapse and even death …”

Section: Introductionmentioning

confidence: 99%

“…Vasopressin, for example, has a short half-life of 10-20 min, and its use has led to rare but serious consequences such as bradycardia, cardiovascular collapse and even death. 13,14 Reversible uterine artery occlusion and permanent uterine artery ligation are two nonpharmacologic approaches to controlling blood loss during myomectomy that have been shown to lower estimated blood loss (EBL), transfusion rates, length of stay and myoma recurrence rates, without significant impact on fertility. 15 The objective of our study is to compare safety protocols and operative outcomes of laparoscopic-assisted myomectomy (LAM) performed at a freestanding ASC versus a hospital outpatient setting (hospital), using the blood loss control techniques of reversible uterine artery occlusion and permanent uterine artery ligation.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

Danilyants¹,

Mamik

MacKoul³

et al. 2020

J of Obstet and Gynaecol

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Aim To compare the safety protocols and operative outcomes of women undergoing laparoscopic‐assisted myomectomy (LAM) by the same surgeons at a freestanding ambulatory surgery center (ASC) versus a hospital outpatient setting. Methods Retrospective chart review of all women ≥18 years old with symptomatic leiomyoma, who underwent LAM with uterine artery occlusion or ligation for blood loss control, at a freestanding ASC between 2013 and 2017, and an outpatient hospital setting between 2011 and 2013, both serving the metropolitan Washington, DC area. The procedures were performed by two minimally invasive gynecologic surgical specialists from a single practice. The safety protocols of each setting were reviewed to identify similarities and differences. Results A total of 816 LAM cases were analyzed (ASC = 588, hospital = 228). The rate of complications was comparable across settings, as was the average myoma weight (ASC = 396.2 g; hospital = 461.5 g; P = 0.064). Operative time was significantly shorter at the ASC: 68 min (95% CI 66–70) versus 80 min at hospital (95% CI 76–84), P < 0.0001. Ambulatory surgery center and hospital protocols differed in limits of preoperative hemoglobin (minimum 9.0 g/dL, 7.5 g/dL respectively), lower nurse/patient ratio in PACU, and were similar in intraoperative surgical safety standards. Conclusion Laparoscopic‐assisted myomectomy can be performed safely and effectively by skilled surgeons at a freestanding ASC, even in patients with morbid obesity or large leiomyoma.

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Intramyometrial vasopressin: A fear for anesthetist?

Cited by 3 publications

References 6 publications

Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy

Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy

Ventricular Tachycardia Caused by Intramyometrial Infiltration of Vasopressin during Laparoscopic Myomectomy: An Anesthesiologist's Nightmare

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

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