Vasopressin overdose
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Bradycardia and vasoconstriction following accidental infiltration: case report A 42-year-old woman developed bradycardia and vasoconstriction following accidental infiltration of a high dose of vasopressin. The woman was diagnosed with uterine leiomyomas and scheduled for a robotassisted laparoscopic myomectomy. She received various induction and maintenance anaesthetics. At 1 hour and 20 minutes after anaesthesia induction, intramyometrial infiltration of the prepared 0.1 U/mL vasopressin was given through a 15-gauge injection cannula. In 2 minutes, she was accidentally infiltrated with 50 units of vasopressin (which was ten-times the recommended dose). Immediately after infiltration of vasopressin, BP decreased to 106/66mm Hg for a minute. One minute into infiltration, BP began to increase to 134/84mm Hg. Heart rate (HR) kept decreasing to 24 bpm at the 2 minute mark. The woman’s vasopressin infiltration was discontinued. The inspired oxygen was set to 100% to compensate for the inability to measure SpO2 owing to a sharp decline in peripheral perfusion index (PPI). The HR increased slowly. The systolic BP of 130 to 150mm Hg and a diastolic BP of 80 to 90mm Hg were maintained without requirement of an additional treatment. Within 3 minutes, her bradycardia resolved. Five minutes after vasopressin infiltration, BP was 150/83mm Hg and HR was 50 bpm. When HR became stable and SpO2 was maintained at 100%, the surgery was resumed. The PPI decreased when bradycardia occurred and could not be measured until bradycardia subsided. The lowest PPI measurement was 0.07 and it gradually increased and reached 2, 1 hour after vasopressin infiltration. The arterial waveform at 5 minutes after vasopressin infiltration showed a relatively high dicrotic notch position, which decreased after 1 hour. The diameter of the brachial and radial arteries also decreased markedly and recovered within 1 hour. Arterial blood gas analysis, which was performed 10 minutes after the infiltration showed an increase in Hb concentration from 9.9–10.9 g/dL. The surgery was concluded without additional events. She was discharged after 2 days with no abnormal findings. Kim JW, et al. Hemodynamic changes following accidental infiltration of a high dose of vasopressin. Journal of International Medical Research 48: No. 9, Jan 2020. Available 803517588 from: URL: http://doi.org/10.1177/0300060520959494
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Reactions 28 Nov 2020 No. 1832
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