Abstract
Vasopressin is a naturally occurring hormone, Vasopressin has multiple effects on different organ systems; however, its primary effect of vasoconstriction finds a place gynaecology surgery to decrease blood loss. As myomas are very vascular tumour, so to reduce significant blood loss and lessen morbidity local vasopressin injection is especially useful. Many potential complications (mainly cardiovascular) of Vasopressin use in gynaecologic procedures have been reported to occur. In the present case, described here the patient received 20 U of vasopressin in dilution of 0.2U/ml after which patient experienced severe bradycardia which was managed quickly. Here we discuss the serious cardiovascular complications of intramyometrial vasopressin, need for use of proper dose and dilution and early anticipation and quick management of potential lethal side effects in patients.
Keywords: vasopressin, bradycardia, intramyometrial.
References
- Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997; 90:967-973.
- Iverson RJ, Chelmow D, Strohbehn K, Waldman L, Evantash E. Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol. 1996;88:415-419.
- West S, Ruiz R, Parker WH. Abdominal myomectomy in women with very large uterine size. Fertil Steril. 2006;85:36-39.
- Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol. 2000;183:1448- 1455.
- Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv. 1995;50:795-80
- Dillon TF. Vasopressin as a hemostatic in gynecologic surgery. Am J Obstet Gynecol. 1959;78:1285–1291
- Kimura T, Kusui C, Matsumura Y, et al. Effectiveness of hormonal tourniquet by vasopressin during myomectomy through vasopressin V1a receptor ubiquitously expressed in myometrium. Gynecol Obstet Invest. 2002;54:125–131.
- Maggi M, Del Carlo P, Fantoni G, et al. Human myometrium during pregnancy contains and responds to V1 vasopressin receptors as well as oxytocin receptors. J Clin Endocrinol Metab. 1990;70:1142–1154.
- Helmer H. Oxytocin and vasopressin 1a receptor gene expression in the cycling or pregnant human uterus. Am J Obstet Gynecol. 1998;179: 1572–1578.
- Hung MH, Wang YM, Chia YY, Chou YM, Liu K Intramyometrial injection of vasopressin causes bradycardia and cardiac arrest – report of two cases. Acta Anaesthesiol Taiwan 2006; 44:243-247.
- Thiek JL, Choudhury SS, Ali J. Vasopressin in myomectomy- effectiveness and its sequelae. New Indian J OBGYN 2016;3:24-8
- Hobo R, Netsu S, Koyasu Y, Tsutsumi O. Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy. Obstet Gynecol 2009; 113:484-6.
- Kim SY, Lee JH, Bang EC, Lee HS, Kang YI, Cho KS, et al. Pulmonary edema following intramyometrial injection and paracervical infiltration of vasopressin during laparoscopic myomectomy and LAVH (Laparoscopic abdominal vaginal hysterectomy): A report of 2 cases. Anesth Pain Med 2010;5:333-7.
- Tulandi T, Beique F, Kimia M. Pulmonary edema: A complication of local injection of vasopressin at laparoscopy. Fertil Steril 1996;66:478-80
- Nezhat F, Admon D, Nezhat CH, Dicorpo JE, Nezhat C. Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy. J Am Assoc Gynecol Laparosc 1994;2:83-6
- Chilkoti G, Mohta M, Nath S, Saxena AK, Khurana P. Anesthetic concerns with intramyometrial vasopressin during myomectomy. Ain Shams J Anaesthesiol 2016;9:452-4.
- Deschamps A, Krishnamurthy S. Absence of pulse and blood pressure following vasopressin injection for myomectomy. Can J Anaesth 2005;52:552-3.
- Lurie S, Mamet Y. Transient myocardial ischemia may occur following subendometrial vasopressin infiltration. Eur J Obstet Gynecol Reprod Biol 2000;91:87-9.
- LeeGG, BaekSY, Woo KimT, JeongCY, RyuKH, ParkDH. Cardiac arrest caused by intramyometrial injection of vasopressin during a robotic-assisted laparoscopic myomectomy. J Int Med Res 2018;46:5303-8
- Kabade SD, Sachidananda R, Wilson E, Divater SB. Intramyometrial vasopressin: A fear for anesthetist? Saudi J Anaesth 2017;11:494-5.
- Malla UJ, Rong ZS. Role of vasopressin in myomectomy. IJSIT 2018;7:183-7.
- Frishman G. Vasopressin: If some is good, is better? Obstet Gynecol 2009;113:476-7.
- Karna ST, Pandey CK, Pandey VK, Dhankhar M. Bradycardia induced polymorphic ventricular tachycardia during living donor liver transplantation. Indian J Anaesth 2016;60:610-2
- Butala BP, Shah VR, Parikh BK, Jayaprakash J, Kalo J. Bradycardia and severe vasospasm caused by intramyometrial injection of vasopressin during myomectomy. Saudi J Anaesth 2014; 8:396–398
Corresponding Author
Dr Trishagni Talukdar
Department of Anaesthesia and Critical Care, Silchar Medical College and Hospital, Assam, India
Guwahati-781003, Assam