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CARDIOVASCULAR ANESTHESIA

Ornipressin (Por 8): An Efficient Alternative to Counteract Hypotension During Combined General/Epidural Anesthesia

Marc De Kock, MD^*, Pierre-Francois Laterre, MD^*, Patricia Andruetto, MD, Lionel Vanderessen, MD^*, Sylvie Dekrom, MD^*, Bernard Vanderick, MD^*, and Patricia Lavand’homme, MD^*

Departments of Anesthesiology, *University of Louvain, St. Luc Hospital, Brussels, Belgium, and University of Torino, Molinette Hospital, Torino, Italy

Address correspondence and reprint requests to Marc De Kock, MD, Department of Anesthesiology, St. Luc Hospital, av. Hippocrates 10–1821, 1200 Brussels, Belgium. Address e-mail to dekock{at}anes.ucl.ac.be

We sought to evaluate the efficacy and side effect profile of a small dose of ornipressin, a vasopressin agonist specific for the V1 receptor, administered to reverse the hypotension associated with combined general/epidural anesthesia. A total of 60 patients undergoing intestinal surgery were studied. After the induction of anesthesia, 7–8 mL of bupivacaine 0.5% with 2 µg/kg clonidine and 0.05 µg/kg sufentanil after an infusion of 5 mL of bupivacaine 0.06% with 0.5 µg · kg^-1 · h^-1 clonidine and 0.1 µg/h of sufentanil were administered by an epidural catheter placed at T7-8 vertebral interspace. When 20% reduction of baseline arterial blood pressure developed, patients were randomly assigned to receive, in a double-blinded design, dopamine started at 2 µg · kg^-1 · min^-1, norepinephrine started at 0.04 µg · kg^-1 · min^-1, or ornipressin started at 1 IU/h. Fifteen patients presenting without hypotension were used as control subjects. Beside routine monitoring, S-T segment analysis, arterial lactacidemia, and gastric tonometry were performed. Ornipressin restored arterial blood pressure after 8 ± 2 vs 7 ± 3 min in the norepinephrine group and 11 ± 3 min in the dopamine group (P < 0.05). This effect was achieved with 2 IU/h of ornipressin in most of the patients (11 of 15). Ornipressin did not induce any modification of the S-T segment; however, it significantly increased intracellular gastric PCO₂ (P < 0.05), indicating splanchnic vasoconstriction.

Implications: In the population studied, small-dose ornipressin was effective to restore arterial blood pressure without causing major ischemic side effects.

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