Vasopressin as a Chemical Tourniquet During Vaginal Surgery

Abstract

We attempted to determine whether vasopressin injected during vaginal surgery decreases intraoperative blood loss without compromising intraoperative or postoperative results. To test this hypothesis, 35 women undergoing vaginal hysterectomy, with or without vaginal repair, were given intracervical (hysterectomy) or intravaginal (vaginal repair) vasopressin (10 units/30 ml normal saline). They were compared with 35 matched controls not receiving vasopressin as to blood loss during surgery, intraoperative clinical effects of vasopressin, postoperative infections, and incidence of delayed bleeding. A matched-pairs i-test was used for continuous variables, and Chi-square analysis was used for categorical variables. We found that the vasopressin group had significantly less intraoperative blood loss (296 ± 37 ml vs 435 ± 55 ml) (p < 0.02). Vasopressin significantly elevated both the mean systolic pressure (106 ± 2 mm Hg vs 114 ± 2 mm Hg) (p < 0.001) and diastolic blood pressure (67 ± 2 mm Hg vs 76 ± 2 mm Hg) (p < 0.001) but was not associated with adverse clinical effects. Postoperative infection was not statistically different in the vasopressin (0/35) and control groups (3/35) [X2(l) = 3.21] (0.05 < p < 0.10). Delayed hemorrhage in the vasopressin group (0/35) was significantly less than in the control group (4/35) [X2(l) = 4.52](p < 0.05). We conclude that vasopressin decreases intraoperative blood loss in vaginal surgery without complicating the intraoperative and postoperative outcome. It may not be a good choice in patients with hypertension, but we did not study enough patients with significant hypertension to draw such conclusions. (J GYNECOL SURG 9:161, 1993) Address reprint request to:

Vasopressin to Control Blood Loss during Hysterectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…The end result is a favorable reduction in the amount of blood loss during hysterectomy. This conclusion is indeed supported by our meta-analysis and in line with previous retrospective studies which demonstrated the significant superiority of vasopressin over normal saline in decreasing intraoperative blood loss during vaginal hysterectomy [22,23]. Owing to its encouraging effects on controlling intraoperative blood loss, vasopressin has been extensively used in diverse gynecological procedures [11], including hysteroscopy [24], myomectomy [25], cesarean section complicated by placenta previa [26], and evacuation abortion [27].…”

“…Compared with epinephrine that has a plasma half-life of 5-6 hours [28], vasopressin favorably exhibits a shorter half-life of 20-30 minutes as well as a shorter duration of action of <1 hour [29]. These pharmacokinetic properties may ascribe to the favorable safety profile of vasopressin.…”

Effects of Cervical Vasopressin Versus N O Cervical Vasopress in on Blood Loss During Vaginal Hysterectomy

“…Julian et al (1993) concluded that vasopressin group had significantly less intraoperative blood loss (296±37 ml) versus 435±55 ml (control group) (p<0.02). 9 Frederick et al (1996) showed a decrease in median blood loss from 675 ml in the placebo group to 225 ml in the vasopressin arm (p<0.001) during myomectomy.In present study average change in haemoglobin (gm%)±SD in control group is 0.691±0.202 and in study group 0.328±0.144, p value=0.000000 (statistically significant). Maximum number of patients in study group had change in haemoglobin from 0.21 to 0.4 gm% while in control group maximum number of patients belonged to change in haemoglobin from 0.41 to 0.6 gm%.…”

Evaluation of outcome following paracervical infiltration with or without saline and adrenaline during vaginal hysterectomy

“…Recently some studies have used Dilute Vassopression during vaginal hysterectomy. 3 Most Gynecologists use Local infiltration before vaginal hysterectomy. In a survey conducted in UK 86 percent of Gynecologists uses infiltration before vaginal hysterectomy.…”