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CARDIOVASCULAR ANESTHESIA

Vasopressin During Spinal Anesthesia in a Patient with Primary Pulmonary Hypertension Treated with Intravenous Epoprostenol

Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri

Address correspondence and reprint requests to Charles Hogue, MD, Campus Box 8054, 660 S. Euclid Avenue, St Louis, MO 63110–1093. Address email to hoguec{at}wustl.edu

Primary pulmonary hypertension (PPH) is a progressive disease with frequent morbidity and mortality, including the risk of cardiac decompensation and death, during general anesthesia. Administration of IV epoprostenol (Flolan) improves symptoms and survival of patients with PPH and thus is an increasingly used long-term treatment for this condition. This therapy is associated with impaired platelet aggregation, which may complicate the perioperative management of patients with PPH. We present a case report of a patient with severe PPH receiving a continuous epoprostenol infusion undergoing skin grafting for a leg ulcer under spinal anesthesia. An IV infusion of vasopressin was given to prevent systemic hypotension resulting from sympathetic blockade while avoiding increases in pulmonary vascular resistance that may have resulted from catecholamine usage.

IMPLICATIONS: Primary pulmonary hypertension (PPH) is a progressively fatal disease that is associated with cardiovascular collapse and death with general anesthesia. We present a patient with PPH who underwent skin grafting under spinal anesthesia while receiving a continuous IV epoprostenol infusion. IV vasopressin was used to avoid systemic hypotension associated with spinal anesthesia.

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