Intramyometrial vasopressin as a haemostatic agent: Is it really safe?

Muthukumar, M; Mathews, Lailu; Vasantha, NS; Anoop, Shajith

doi:10.4103/0019-5049.149456

Cited by 8 publications

(10 citation statements)

References 7 publications

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“…The effects include reduced cardiac output and heart rate resulting from vasoconstriction. 2 In the above case report patient exhibited bradycardia after infiltrating with vasopressin intramyometrially. Pinprick test performed after spinal anesthesia ruled out chances of high spinal anesthesia.…”

Section: Discussionmentioning

confidence: 88%

A case report of vasopressin induced bradycardia and dyspnea after intramyometrial injection during myomectomy

Bokka¹,

Vadhanan²,

Megha³

et al. 2020

IJCA

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Injecting vasopressin intramyometrially reduces bleeding during myomectomy. It is challenging to the anesthesiologist in view of its side effects. Low concentrations of vasopressin has been considered to be safe, but sometimes it can lead to undesirable effects such as bradycardia with loss of peripheral pulse, non recordable blood pressure further leading to cardiac arrest. We report a case history of a patient who had developed bradycardia and dyspnea along with loss of peripheral pulse after local infiltration of 5 unit of vasopressin (20units diluted in 100ml NS), patient was revived by successful resuscitation.

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Section: Discussionmentioning

confidence: 88%

A case report of vasopressin induced bradycardia and dyspnea after intramyometrial injection during myomectomy

Bokka¹,

Vadhanan²,

Megha³

et al. 2020

IJCA

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“…The vasoconstrictive effect of vasopressin causes coronary artery vasospasm that causes cardiac ischaemia, infarction and arrest. [ 12 27 28 29 ]…”

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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“…These cardiac effects are potentiated in patients with coronary insufficiency. [1] In this case, after intramyometrial injection of vasopressin, patient had bradycardia, hypotension with documented myocardial event. This suggests the possibility of cardiac failure which may have resulted in her death.…”

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confidence: 92%

“…[123] The systemic effects of vasopressin pose significant challenges for the anesthesiologist as it may cause bradycardia, hypotension and fatal cardiac complications such as arrhythmias and cardiac arrest. [456] We report a case of intramyometrial injection of vasopressin and further discuss adverse effects and complications related to it.…”

mentioning

confidence: 99%

“…[4] Vasopressin at higher concentrations in circulation produces generalized constriction of blood vessels including coronaries. [1] This effect on the myocardium results in reduced cardiac output and heart rate, decreased coronary blood flow, altered sympathetic tone and potentiated baroreflex due to generalized vasoconstriction. These cardiac effects are potentiated in patients with coronary insufficiency.…”

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confidence: 99%

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