Hemodynamic Effects of Phenylephrine, Vasopressin, and Epinephrine in Children With Pulmonary Hypertension: A Pilot Study*

Siehr, Stephanie L.; Feinstein, Jeffrey A.; Yang, Weiguang; Peng, Lynn F.; Ogawa, Michelle; Ramamoorthy, Chandra

doi:10.1097/pcc.0000000000000716

Cited by 50 publications

(35 citation statements)

References 19 publications

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“…However, the addition of vasopressin had no effect on this parameter in either group, during either normoxic or hypoxic ventilation. These data are in accord with recent studies of vasopressin in pulmonary hypertension that, while noting a vasopressin‐induced decrease in the pulmonary‐to‐systemic pressure ratio, ascribe this improvement to a rise in aortic pressure rather to pulmonary vasodilation . Vasopressin may be unique among pressors in having no pulmonary constrictor effect, but we concur that it has no apparent pulmonary vasodilator effect .…”

Section: Discussionsupporting

confidence: 91%

Effect of vasopressin on a porcine model of persistent pulmonary hypertension of the newborn

Amer

Elsayed

Graham

et al. 2019

Pediatric Pulmonology

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Background Persistent pulmonary hypertension of the newborn (PPHN) is due to a failure of pulmonary vascular relaxation. Vasopressin, a systemic vasoconstrictor acting on smooth muscle AVPR1a receptors, is used in treatment of PPHN. We sought to determine acute effects of vasopressin infusion on pulmonary hemodynamics in a large animal model of hypoxic PPHN. Methods PPHN was induced in 6 newborn piglets by 72 h normobaric hypoxia (FiO2 = 0.10); controls were 7 age‐matched 3‐day‐old piglets. Animals were anesthetized and ventilated with central venous and arterial lines, and after stabilization, randomized using a crossover design to normoxic or hypoxic ventilation, then 30 min infusion of 0.0012 U/kg/min vasopressin, followed by 45 min vasopressin washout period. Echocardiographic parameters and oxygen consumption were measured before and after vasopressin. Relaxation to vasopressin was tested in isolated PPHN and control pulmonary arteries by isometric myography. Expression of AVPR1a receptor mRNA was quantified in arterial and myocardial tissues. Results Vasopressin did not alleviate hypoxia‐responsiveness of PPHN pulmonary circuit. There were no significant differences in pulmonary hypertension, cardiac function indices, or oxygenation indices after vasopressin infusion. Vasopressin did not dilate control or PPHN pulmonary arteries, and AVPR1 was minimally expressed. Conclusions Vasopressin does not have a direct pulmonary vasodilator effect in PPHN, within the timeframe studied.

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Section: Discussionsupporting

confidence: 91%

Effect of vasopressin on a porcine model of persistent pulmonary hypertension of the newborn

Amer

Elsayed

Graham

et al. 2019

Pediatric Pulmonology

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“…Vasoactive agents such as milrinone, dobutamine, or low dose epinephrine, are chosen to improve inotropy while decreasing SVR. When dealing with systemic hypotension, particularly in the face of concomitantly increasing PVR, vasopressin may be an effective option for reversing these trends while maintaining MAP and perfusion [12].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management During Stenting of Obstructed Total Anomalous Pulmonary Return in a Neonate With Single Ventricle Anatomy

et al. 2017

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Total anomalous pulmonary venous return (TAPVR) is a relatively rare congenital cardiac abnormality accounting for 1.5-3% of cases of congenital heart disease (CHD). Despite advances in surgical technique, surgical repair of TAPVR continues to be associated with a significant incidence of perioperative mortality. Morbidity and mortality associated with surgical repair of TAPVR increase dramatically when there are other associated cardiac defects, particularly single ventricle anatomy. We present a neonate with obstructed TAPVR and an unbalanced atrioventricular canal defect with hypoplastic left ventricle who presented for an interventional cardiac catheterization procedure (stenting of an obstructed vertical vein). The anesthetic management of such patients is discussed and options for intraoperative care are presented.

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“…Studies in adults undergoing cardiac surgery compared vasopressin to norepinephrine for treatment of vasoplegic shock and found that patients receiving vasopressin had lower mortality, shorter ICU stay, and lower incidence of renal injury . Phenylephrine, an alpha 1 agonist, has a similar vasoconstrictive effect on the systemic vasculature but, unlike vasopressin, causes a dose‐dependent degree of pulmonary vasoconstriction . Norepinephrine has primarily alpha 1 receptor activity and produces vasoconstriction with a mild inotropic effect.…”

Section: Medical Treatment Of Hypotensionmentioning

confidence: 99%

Current perspectives on treatment of perioperative hemodynamic instability and hypotension

Joffe

Latham

Ross

2019

Pediatric Anesthesia

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Summary Overall, there are numerous causes of hypotension in the perioperative period. The approach to definitive treatment must be tailored to the child's unique anatomy and physiology, as well as the current factors presumed to be eliciting the hypotensive state. It is imperative to consider both routine and lesion‐specific etiologies to the current hypotensive episode. Lastly, when employing pharmacologic therapy for hypotension, there are often multiple combinations of medications that can reasonably be used to achieve the desired hemodynamic effects.

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Hemodynamic Effects of Phenylephrine, Vasopressin, and Epinephrine in Children With Pulmonary Hypertension: A Pilot Study*

Cited by 50 publications

References 19 publications

Effect of vasopressin on a porcine model of persistent pulmonary hypertension of the newborn

Effect of vasopressin on a porcine model of persistent pulmonary hypertension of the newborn

Anesthetic Management During Stenting of Obstructed Total Anomalous Pulmonary Return in a Neonate With Single Ventricle Anatomy

Current perspectives on treatment of perioperative hemodynamic instability and hypotension

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