Reactions 1516, p181 - 30 Aug 2014

O SVasopressin overdose

Bradycardia and severe vasospasm: case reportA 43-year-old woman developed bradycardia and severe

vasospasm following vasopressin overdose.The woman with multiple uterine fibroids was undergoing

open myomectomy under spinal anaesthesia with bupivacaineand fentanyl. Her heart rate dropped to 28/minute with ECGshowing sinus bradycardia, approximately 30 minutes after thesubarachnoid block. There was intense facial pallor. Thoughher carotid’s were palpable, her radial pulse could not be felt.Her pulse oximeter became flat. The next blood pressure cycledid not register a value. She received atropine and 100%oxygen was delivered using assisted ventilation and 100 ml offluid was infused rapidly. Her level of spinal anaesthesia wasequivocal at T4-T6. When inquired, the surgeon revealed that20 ml of 1 Unit/ml vasopressin was injected intra-myometriallyafter confirming negative aspiration of blood. After 30 secondsof injecting vasopressin, she had developed bradycardia andsevere vasospasm. Her tongue was papery white and shecomplained of nausea and vomiting. Her blood pressure was216/144 mmHg.

The woman received nitroglycerin within 1 minute, and herpulse increased to 120/minute. Over the next 25 minutes, herpulse rate subsided to 90/minute and blood pressure to110/76 mmHg. She was comfortable with spontaneousrespiration with 100% oxygen saturation. Further surgery wasuneventful and she was shifted to the recovery room andmonitored there for 24 hours.

Author comment: "We herein report a case of suddensevere bradycardia and vasospasm immediately after amyometrial injection of vasopressin and discuss the potentialadverse effects and related complications." "The dose ofvasopressin administered to our patient (20 U in 20 ml saline)substantially exceeded [the] recommended limits."Butala BP, et al. Bradycardia and severe vasospasm caused by intramyometrialinjection of vasopressin during myomectomy. Saudi Journal of Anaesthesia 8:396-398, No. 3, Jul-Sep 2014. Available from: URL: http://doi.org/10.4103/1658-354X.136630 - India 803107571

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Reactions 30 Aug 2014 No. 15160114-9954/14/1516-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved