Vasopressin May Be Useful in the Treatment of Systemic Anaphylaxis in Rabbits

Abstract

Recent studies demonstrate that vasopressin is useful when treating hemorrhagic and septic shock. The effect of vasopressin on systemic anaphylaxis has not been investigated except in clinical case reports. Vasopressin increases blood pressure because of vasoconstriction through the V1 receptor. Thus, we evaluated the effect of vasopressin on circulatory depression and bronchoconstriction provoked by systemic anaphylaxis and survival rates in rabbits. In the first set of experiments, 15 nonsensitized rabbits received normal saline (control) and vasopressin at 0.8 or 0.08 U/kg. In the second set, 40 sensitized rabbits received horse serum to induce anaphylaxis, and then received the same drugs as in the first set. In the first set, mean arterial pressure (MAP) in vasopressin groups increased by 18% to 24% compared with the control. Vasopressin at 0.8 U/kg decreased MAP insignificantly before the increases of MAP occurred. In the second set, vasopressin at 0.08 U/kg improved the survival rate. At 45 min after antigen challenge, 69% of the rabbits that received vasopressin at 0.08 U/kg were alive, whereas 29% of the control rabbits and 23% of the rabbits that received vasopressin at 0.8 U/kg were alive. Vasopressin increased MAP by 36% to 109% compared with the control within 5 min, however, at 2 min, vasopressin at 0.8 U/kg had no effect on MAP. Pulmonary dynamics were similar. In conclusion, vasopressin at 0.08 U/kg improved survival rates and severe hypotension provoked by systemic anaphylaxis, suggesting that this agent may be useful in the treatment of systemic anaphylaxis.

Anaphylactic Shock Decreases Cerebral Blood Flow More Than What Would Be Expected From Severe Arterial Hypotension

“…In addition, the idea of an initially preserved CO has also been challenged in several animal models of AS. Although several interspecies differences may exist, impaired myocardial contractility has been demonstrated in lethal models of anaphylaxis (18,19), whereas less severe myocardial depression was observed in nonlethal models (20). In addition, an increase in venous tone in the splanchnic and portal vascular beds, with a presinusoidal contraction within the liver, as well as in the pulmonary veins resulting in a rapid decrease in preload and CO has been reported recently (21Y23).…”

Case report: Treatment of rocuronium-induced anaphylactic shock with vasopressin

“…This study revealed that vasopressin was able to improve survival rates and severe hypotension provoked by systemic anaphylaxis. 25 in conclusion, while the efficacy of vasopression for the treatment of refractory shock has been well documented, experience is limited with this drug in treating anaphylaxis in patients under general anesthesia. We describe the successful use of low-dose vasopressin, in the management of anaphylaxis to rocuronium, in a patient with no previous exposure to neuromuscular blocking drugs.…”

A Comparison of Epinephrine Only, Arginine Vasopressin Only, and Epinephrine Followed by Arginine Vasopressin on the Survival Rate in a Rat Model of Anaphylactic Shock

“…Recently, experimental work provided arguments for the possible use of AVP as therapy of anaphylactic shock. 12,23,24 In other respects, the most recent American guidelines on anaphylaxis 5,25 and several case reports suggested that adding AVP to standard therapy might be considered as a potential therapeutic approach in anaphylactic shock. 9 -11 In the wake of these case reports and taking into account a possible AVP deficiency observed in experimental anaphylactic shock, 12 we compared, in an anesthetized Brown Norway rat model of anaphylactic shock, the survival rate according to the drug injected, epinephrine and/or AVP.…”