On the path to surgical nirvana
No gynecologic surgical procedure is more rewarding than one completed successfully with minimal blood loss; with the operating field as pristine at the end as it was at the beginning; with one sponge with a spot of blood; and with the patient safely in the recovery room. Vasopressin has a role in reaching for this ideal, but you must use it in dilution and at a low total dosage.
Using vasopressin? Reduce the risk of adverse effects with these procedural tips
Solution
Dilute the vasopressin in the range of 0.1 to 0.2 U/mL. Avoid concentrations >1 U/mL.
Vitals
Alert the anesthesiologist and the surgical team before you inject vasopressin, so that they are vigilant for changes in vital signs. Don’t inject if vitals are unstable.
Insufflation
The pneumoperitoneum necessary for laparoscopic surgery may increase the risk of bradycardia.1 The combined pneumoperitoneum and intravascular injection of vasopressin is likely to increase the risk of cardiovascular changes.
Injection
Double-check that you are not injecting into a blood vessel by carefully testing the results of negative aspiration applied to the syringe.
Dosage
Don’t exceed a total dosage of approximately 5 units. Using a solution of 0.1 U/mL, the maximum injection is 50 mL.
Repeat dose
Vasopressin has a relatively short half-life in circulation. Repeat injection, 45 to 60 minutes after the first, may be safe.
Nicotine
Does your patient smoke or use a nicotine replacement medication? Be especially cautious about the possible synergistic effect that nicotine plus vasopressin may have on vasoconstriction.
Cardiovascular pitfalls
Be cautious about using vasopressin in a patient who has established coronary artery or myocardial disease.
References
1. Reed DN, Duff JL. Persistent occurrence of bradycardia during laparoscopic cholecystectomies in low-risk patients. Dig Surg. 2000;17(5):513-517.