The effect of vasopressin on the hemodynamics in CABG patients

Abstract

BackgroundVasopressin is widely used to treat various type of hypotension, but the effect of vasopressin on coronary artery bypass grafting surgery (CABG) patients is not clear. This study was to investigate the effect of vasopressin on the hemodynamics in CABG patients.MethodsTwenty coronary artery disease (CAD) patients were randomly divided into two groups: norepinephrine group and vasopressin group. During the anesthesia and the operation, the central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were maintained to 8-10cmH2O, and the hemocrit was maintained above 30% through lactate ringer’s mixture, artifact colloid and red blood cells. The invasive artery blood pressure (IBP) was maintained by appropriate anesthetic depth and norepinephrine or vasopressin respectively. The target IBP was 70 mmHg, and heart rate (HR) was 60 bpm. The MAP (mean artery pressure), HR, ST-T, CVP, PAP (pulmonary artery pressure), PCWP, SVR (systemic vascular resistance), PVR (pulmonary vascular resistance), CO (cardiac output), urine output, blood gas analysis, surgery duration and blood loss were monitored.ResultsThe MAP, HR, and ST-T were stable in either group during the operation. CVP, PCWP and SVR increased but CI deceased during the posterior descending artery (PDA) was grafted in both groups and without any significant difference between them. PAP increased during PDA was grafted in either group and there was significant difference between the two groups. PVR increased during ADA and PDA being grafted in norepinephrine group but not in vasopressin group. Metoprolol usage was 11.2 mg and 5.9 mg in norepinephrine group and vasopressin group respectively.ConclusionVasopressin was better than norepinephrine.to keep the hemodynamics stability of patients undergoing CABG surgery.

Effect of arginine vasopressin on systemic and pulmonary arterial pressure in a patient with pulmonary hypertension secondary to pulmonary emphysema: a case report

“…In vitro and in vivo studies have demonstrated that AVP produces systemic vasoconstriction with relatively fewer effects on the pulmonary circulation; such combined effects produce a desirable decrease in the pulmonary vascular resistance/systemic vascular resistance ratio [ 12 – 14 ]. This AVP-mediated selective vasoconstriction of the systemic vessels has also been shown in several clinical studies in patients undergoing cardiac surgery [ 4 – 6 ]. However, the pathological mechanisms of PH in patients who undergo cardiac surgery are different from those in patients with PH secondary to lung diseases.…”

“…Surgery and anesthesia pose a significant risk for patients with pulmonary hypertension (PH) [ 1 – 3 ]; therefore, perioperative management of these patients presents a major challenge to physicians. Several studies in patients undergoing cardiac surgery have demonstrated that arginine vasopressin (AVP) can effectively ameliorate systemic hypotension without increasing pulmonary vascular resistance [ 4 – 6 ]. These results support the administration of AVP for the treatment of hypotension concomitant with PH in the cardiac surgery setting.…”

Vasopressin therapy in cardiac surgery

“…Yimin et al studied the differences between NE and AVP monotherapies for hypotension in 20 patients undergoing CABG. There was no significant differences between the two therapies but the pulmonary artery pressures were higher in the norepinephrine group . One of the largest prospective studies to examine this was the VANCS trial, which randomized 330 patients with post‐CPB vasodilatory shock to norepinephrine (10‐60mcg/min) or AVP (0.01‐0.06 U.min).…”

“…There was no significant differences between the two therapies but the pulmonary artery pressures were higher in the norepinephrine group. 36 One of the largest prospective studies to examine this was the VANCS trial, which randomized 330 patients with post-CPB vasodilatory shock to norepinephrine (10-60mcg/min) or AVP (0.01-0.06 U.min). The study excluded LVAD and OHT populations.…”

Sixty Years since Vasopressin Synthetic Preparation Followed by a Nobel Prize. Is it Time to Augment its Use in Cardiac Surgery?

“…7 The first reports for AVP use in cardiac surgery, by Argenziano et al 8 & Masetti et al, 9 showed promising results referring to its use for separation from cardiopulmonary bypass. More recently, Elgebaly et al 10 & Yimin et al 11 suggested the beneficial role of vasopressin in supporting circulation after heart operations against various conditions, such as low ejection fraction, extended vasodilatation from ACE inhibitors and long bypass time for complex operations.…”