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Anesth Analg 2006;102:1908
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000215135.44887.7E

LETTER TO THE EDITOR

Bolus Vasopressin During Hemorrhagic Shock?

Jonathan V. Roth, MD

Department of Anesthesiology; Albert Einstein Medical Center; Philadelphia, PA; rothj{at}einstein.edu

To the Editor:

In their case report, Sharma and Setlur (1) report two hypotensive patients whose blood pressures were poorly responsive to catecholamines but then increased in response to infusions of 0.04 U/min of vasopressin. One patient's arterial blood pressure started increasing after 1 h of vasopressin; the other's began increasing after 30 min. There was no mention of either patient receiving an initial bolus dose of vasopressin. The accompanying editorial recognized that there are limited clinical data on timing and dosage of vasopressin administration (2). These articles support the idea that vasopressin has a valuable role, although controlled studies are needed and dosing guidelines need to be established (2).

With many medications, a bolus is often given before an infusion to obtain a more rapid response. However, because of the potential side effects and lack of supporting data, one may hesitate to administer a bolus of vasopressin. For this reason, I present some of my experience with bolus vasopressin.

During open abdominal aortic aneurysm surgery, patients will sometimes develop hypotension not responsive to catecholamines during bowel retraction. I will then administer 1 or 2 boluses of vasopressin, 0.4 U, by IV push. This is typically sufficient to treat the hypotension. I have not observed any evidence of myocardial ischemia by electrocardiogram monitoring. The dose of 0.4 U is 2 orders of magnitude less than the 40 U recommended in Advanced Cardiac Life Support protocols.

Admittedly, this is a very different situation than hemorrhagic shock. However, my experience provides some support to the safety of 0.4 U IV push vasopressin in a patient population who is at increased risk for myocardial ischemia. I present this not as a recommendation but as a starting point for adequate and well-controlled studies to establish the safety and efficacy of bolus vasopressin for rapid correction of hypotension.

References

  1. Sharma RM, Setlur R. Vasopressin in hemorrhagic shock. Anesth Analg 2005;101:833–4.[Abstract/Free Full Text]
  2. Stadlbauer KH, Volker W, Krismer AC, et al. Vasopressin during uncontrolled hemorrhagic shock: less bleeding below the diaphragm, more perfusion above. Anesth Analg 2005;101:830–2.[Free Full Text]



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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press