Review of Vasopressin Use in Gynecologic Surgery

Chudnoff, S.; Glazer, Sivan; Levie, M.

doi:10.1016/j.jmig.2012.03.022

Cited by 10 publications

(17 citation statements)

References 65 publications

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“…Our survey found that perioperatively, 29% ( n = 86) of gynecologists use vasopressin to minimize blood loss. This relatively low rate may reflect concerns that have been raised recently concerning the safety of vasopressin [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants

2017

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BackgroundThe demand for uterus-sparing treatments is increasing as more women postpone childbirth to their 30–40s, when fibroids are more symptomatic. With an increasing choice of treatment options and changing care-provider profiles, now is an opportune time to survey current practices and opinions. Using a 25-stem questionnaire, a web-based survey was used to capture the practices and opinions of UK consultant gynecologists on the treatment of symptomatic fibroids, including the types of procedure most frequently used, methods used to reduce blood loss, and awareness and acceptability of treatment options, and to assess the impact of gender and experience of the treating gynecologist.ResultsThe response rate was 22%. Laparascopic myomectomy is used least frequently, with 80% of the respondents using GnRHa preoperatively to minimize blood loss and correct anemia, while vasopressin is most frequently used to reduce intraoperative blood loss. Female consultants operate significantly less frequently than males. Those with more than 10 years consultant experience are more likely to perform an open myomectomy compared to those with less than 10 years experience.ConclusionsCompared to a similar survey performed 10 years ago, surgical methods remain to be the most common treatments, but use of less invasive treatments such as UAE has increased. Consultants’ attitudes appear to be responding to the patient demand for less radical treatments. However, it is yet to be seen if the changing consultant demographics will keep up with this demand. The low response rate warrants cautious interpretation of the results, but they provide an interesting snapshot of current views and practices.Electronic supplementary materialThe online version of this article (doi:10.1186/s10397-017-1014-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants

2017

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“…The regular concentration is 0.2 U/mL, but the minimum concentration with therapeutic effect has been reported to be 0.05 U/mL. 3 …”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 When infiltrated, vasopressin reduces hemorrhage, which is the most common complication during gynecological surgery, through its vasoconstrictive and uterine contraction effects, shortens the duration of surgery, and prevents additional complications such as infection. 3 However, cautionary measures should be taken against life-threatening complications such as pulmonary edema and cardiac arrest, 1 and it is recommended that the total dosage of vasopressin does not exceed 4 to 6 U. Vasopressin should also be diluted because the risk of complications increases with inadvertent intravascular injection. The regular concentration is 0.2 U/mL, but the minimum concentration with therapeutic effect has been reported to be 0.05 U/mL.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 Consequently, vasopressin local infiltration can reduce hemorrhage (which is the most common complication of gynecological surgery), shorten the duration of surgery, and prevent additional complications such as infection. 3 However, cautionary measures should be taken against life-threatening complications, such as pulmonary edema and cardiac arrest, which are associated with vasopressin. 1 …”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic changes following accidental infiltration of a high dose of vasopressin

Kim

et al. 2020

J Int Med Res

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Vasopressin local infiltration is useful in gynecological surgery because it can reduce hemorrhage. Depending on the activities of the sympathetic system and the renin–angiotensin system, reactions to vasopressin may differ and predicting its systemic effects is difficult. Because life-threatening complications can occur, infiltration with vasopressin should be administered with caution. A 42-year-old female patient was diagnosed with uterine leiomyomas. During a robot-assisted laparoscopic myomectomy, 50 U of vasopressin, which is ten-times the recommended dose, was accidentally infiltrated. Subsequently, bradycardia with a heart rate of 25 bpm occurred, which recovered within 3 minutes. Peripheral perfusion indices and the diameter of the radial and brachial arteries also decreased markedly and recovered within 1 hour. The surgery was concluded without additional events. The patient was discharged 2 days later with no abnormal findings. Because vasopressin infiltration can cause life-threatening complications, it is necessary to determine the extent of patient reactions to vasopressin using measures such as the peripheral perfusion index or radial and brachial artery diameters. These measures may also help to predict the occurrence of complications.

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“…In gynecologic surgery, vasopressin has been used since the 1950s. The utilization of intracervically administered vasopressin has been shown to limit the amount of bleeding and intravasation by its primary effect of vasoconstriction and, therefore, may be of use during hysteroscopic surgery [ 9 , 12 , 16 – 20 ]. In the Netherlands it is common gynecological practice to use terlipressin intracervically to control bleeding during conization.…”

Section: Introductionmentioning

confidence: 99%

The HYSTER study: the effect of intracervically administered terlipressin versus placebo on the number of gaseous emboli and fluid intravasation during hysteroscopic surgery: study protocol for a randomized controlled clinical trial

Overdijk

Rademaker

Kesteren

et al. 2018

Trials

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BackgroundTranscervical resection of myoma or endometrium is a safe, hysteroscopic, minimally invasive procedure. However, intravasation of distension fluid is a common phenomenon during these procedures. In a previous study we observed venous gas emboli in almost every patient. The severity of hysteroscopic-derived embolization has been shown to be correlated to the amount of intravasation. In addition, paradoxical gas embolism, which is potentially dangerous, was observed in several patients.Studies have shown a reduction of intravasation by using intracervically administered vasopressin during hysteroscopy. We think that its analog, terlipressin, should have the same effect. In our previous research we observed more gaseous emboli as intravasation increased. Whether or not the insertion of intracervically administered terlipressin leads to a lower incidence and severity of gas embolism is unknown. We hypothesize that intracervically administered terlipressin leads to a reduction of intravasation with a lower incidence and severity of gas embolism. Terlipressin may be of benefit during hysteroscopic surgery.Methods/designForty-eight patients (ASA 1 or 2) scheduled for transcervical resection of large, types 1–2 myoma or extensive endometrium resection will be included. In a double-blind fashion patients will be randomized 1:1 according to surgical treatment using either intracervically administered terlipressin or placebo. Transesophageal echocardiography will be used to observe and record embolic events. A pre- and post-procedure venous blood sample will be taken to calculate intravasation based on hemodilution. Our primary endpoint will be how terlipressin influences the severity of embolic events. Secondary endpoints include the effect of terlipressin on the amount of intravasation and on hemodynamic parameters.DiscussionIf terlipressin does indeed reduce the number of gaseous emboli and intravasation occurring during hysteroscopic surgery, it would be a simple method to minimize potential adverse events. It also allows for prolonged operating time before the threshold of intravasation is reached, thereby reducing the need for a second operation.Trial registrationNederlands Trial Register (Dutch Trial Register), ID: NTR5577. Registered retrospectively on 18 December 2015.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2442-9) contains supplementary material, which is available to authorized users.

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Review of Vasopressin Use in Gynecologic Surgery

Cited by 10 publications

References 65 publications

Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants

Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants

Hemodynamic changes following accidental infiltration of a high dose of vasopressin

The HYSTER study: the effect of intracervically administered terlipressin versus placebo on the number of gaseous emboli and fluid intravasation during hysteroscopic surgery: study protocol for a randomized controlled clinical trial

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