Reactions 1385 - 21 Jan 2012

SVasopressin

Vasospasm: case reportA 28-year-old woman developed severe vasospasm

following inadvertent administration of vasopressin[Pitressin].

The woman presented for uterine fibroid tumourremoval under general anaesthesia. About 45 minutes afterincision, her BP increased to 165/95mm Hg. Her HRsubsequently dropped to 70 beats/min. Her BP was notmeasurable with the left upper arm cuff, and peripheralpulses were absent. Several minutes prior to the onset ofhaemodynamic instability, intrauterine oxytocin [Pitocin]was injected. Oxytocin-induced global hypotension wassuspected.

Phenylephrine was administered, but the woman’ssymptoms persisted. On further investigation, it wasdiscovered that vasopressin [Pitressin] 60U in 33mL of0.9% sodium chloride had been inadvertently administeredinstead of oxytocin. An ultrasound showed pulsating ulnarand radial arteries at her wrist, measuring about 1mm.Radial artery catheter placement was unsuccessful.Brachial artery cannulation was also unsuccessful. Afterabout 90 minutes, a modest increase was observed in theradial artery diameters, and her left radial artery wassuccessfully cannulated. Surgery was completeduneventfully. Two days postoperatively, her radial andbrachial artery diameters had increased.Riess ML, et al. Severe vasospasm mimics hypotension after high-dose intrauterinevasopressin. Anesthesia and Analgesia 113: 1103-1105, No. 5, Nov 2011.Available from: URL: http://dx.doi.org/10.1213/ane.0b013e31822cef10 -USA 803066095

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Reactions 21 Jan 2012 No. 13850114-9954/10/1385-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved