Anesth Analg 2006;102:1908
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000215143.26601.E8
LETTER TO THE EDITOR
Bolus Vasopressin During Hemorrhagic Shock?
Karl H. Stadlbauer, MD,
Volker Wenzel, MD,
Anette C. Krismer, MD,
Wolfgang G. Voelckel, MD, and
Karl H. Lindner, MD
Department of Anesthesiology and Critical Care Medicine; Innsbruck Medical University; Innsbruck, Austria; karl-heinz.stadlbauer{at}uibk.ac.at
In Response:
We appreciate the comments of Dr. Roth (1) regarding the use of vasopressin discussed in our recent editorial (2). We agree that an initial loading dose of arginine vasopressin may be useful to treat shock, but this depends on the dynamics of the situation. For example, we never inject a bolus dose of arginine vasopressin during vasodilatory shock (3). However, vasopressin may be quite useful in a patient with uncontrolled hemorrhagic shock and collapsing arterial blood pressure (4). Pharmacological mechanisms in normovolemic shock states are very different from those associated with shock in trauma patients with continuing massive hemorrhage (5). It is correct that some injections of a vasopressin bolus were harmful. This occurred when dosages equivalent to cardiopulmonary resuscitation dosages (40 IU) were used during routine surgical procedures. Complications were also reported when vasopressin analogues with several hours duration of action (arginine vasopressin action lasts several minutes) were administered in patients with angiotensin-converting enzyme inhibitor treatment during hypotension after induction of anesthesia (6). As Dr. Roth suggests, injecting a "mini" bolus of 0.4 IU arginine vasopressin (1% of the cardiopulmonary resuscitation dosage) to treat catecholamine-refractory hypotension during anesthesia seems to be a sound approach to increase mean arterial blood pressure sufficiently and allows careful titration as well. We also concur that prospective clinical trials need to be performed before this strategy can be widely recommended.
References
- Roth JV. Bolus vasopressin during hemorrhagic shock? Anesth Analg 2006;102:xxx.
- 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]
- Dunser MW, Wenzel V, Mayr AJ, Hasibeder WR. Management of vasodilatory shock: defining the role of arginine vasopressin. Drugs 2003;63:237–56.[Web of Science][Medline]
- Krismer AC, Wenzel V, Voelckel WG et al. Employing vasopressin as an adjunct vasopressor in uncontrolled traumatic hemorrhagic shock: three cases and a brief analysis of the literature. Anaesthesist 2005;54:220–4.[Web of Science][Medline]
- Haas T, Voelckel WG, Wiedermann F et al. Successful resuscitation of a traumatic cardiac arrest victim in hemorrhagic shock with vasopressin: a case report and brief review of the literature. J Trauma 2004;57:177–9.[Web of Science][Medline]
- Medel J, Boccara G, Van de Steen E et al. Terlipressin for treating intraoperative hypotension: can it unmask myocardial ischemia? Anesth Analg 2001;93:53–5.[Abstract/Free Full Text]
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