Pulmonary edema: a complication of local injection of vasopressin at laparoscopy

Tulandi, Togas; Béı̈que, François; Kimia, Morad

doi:10.1016/s0015-0282(16)58523-9

Cited by 71 publications

(36 citation statements)

References 5 publications

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“…14 There is, however, a concern about potential pharmacological adverse effects associated with accidental intravasation of these drugs, including bradycardia, hypotension, pulmonary oedema, myocardial infarction and even cardiac arrest, to the extent that their use has been banned in some countries. [15][16][17] Another concern that we have with the use of any injectable vasoconstrictor is that the effect may either not cover the entire procedure necessitating repeat injections, or worse, as pointed out by the studies from Jamaica, 13,14 it will mask a bleeding vessel which will then become manifest postoperatively. The same may also apply to drugs which work by inducing myometrial contractions during surgery, such as misoprostol.…”

Section: Discussionmentioning

confidence: 99%

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

Al-Shabibi

Chapman

Madari

et al. 2009

BJOG

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Objective To compare intra-operative blood loss with triple tourniquets to occlude uterine blood supply against preoperative treatment with gonadotrophin-releasing hormone (GnRH) analogues at open myomectomy.Design A prospective randomised controlled trial.Setting University teaching hospital.Population Forty women undergoing open myomectomy for symptomatic fibroids.Methods Women due to undergo open myomectomy were randomised to either 3 months pre-treatment with a GnRH analogue or the intra-operative application of triple tourniquets (number 1 polyglactin suture [Vicryl Ò Ethicon Inc., Somerville, NJ, USA] tied around the cervix and a size 10 polythene suction catheter tied around the infundibulo-pelvic ligaments) to occlude the uterine blood supply.Main outcome measures The primary outcome measure was intra-operative blood loss. Secondary outcome measures included postoperative blood loss, blood transfusion rate and postoperative morbidity. ResultsThe two groups were similar in baseline characteristics. An average of 15 and 22 fibroids were removed from the GnRH analogue and tourniquet groups respectively. Intra-operative estimated blood loss was significantly higher in the GnRH analogue group (median 2482 ml, 75% percentile 1744-3151) than when triple tourniquets were used (median 640 ml, 75% percentile 418-881), giving a difference between means of 1842 ml (P < 0.001). Similarly, significantly more women required blood transfusion in the GnRH analogue group (70 versus 30%, P < 0.025). Postoperative morbidity was similar between the two groups. There were two serious complications in the tourniquet group, but they were not considered to be directly related to occlusion of the uterine blood supply.Conclusions Triple tourniquets are significantly more effective than preoperative treatment with GnRH analogues at reducing intra-operative blood loss at open myomectomy.

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Section: Discussionmentioning

confidence: 99%

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

Al-Shabibi

Chapman

Madari

et al. 2009

BJOG

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“…However, its application is associated with the increase in blood pressure, bleeding at the side of injection, and the risk of pulmonary edema and myocardial infarction [15,16]. So, misoprostol seems to be the best choice in reducing hemorrhage during myomectomy.…”

Section: Discussionmentioning

confidence: 99%

A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial

Niroomand

Hajiha

Tabrizi

et al. 2015

Arch Gynecol Obstet

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“…Historically vasopressin has been used to reduce blood loss at the time of myomectomy due to its vasoconstrictive effects and its use has been documented prior to the resection of cornual ectopic pregnancies. However, caution needs to be observed when using intramyometrial vasopressin, as there have been significant safety concerns reported in the literature including cases of bradycardia, cardiovascular collapse and death [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

A new technique in the laparoscopic resection of cornual ectopic pregnancies: a case series

Mallick

Ajala

2016

Gynecol Surg

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Cornual ectopic pregnancies are a challenging dilemma faced in the early pregnancy setting. They are associated with high morbidity and mortality rates when compared to standard tubal ectopic pregnancies mainly due to their late presentation and significant haemorrhage and hysterectomy risk. Laparoscopic resection has been described successfully; however, the procedure can be technically very challenging and can carry significant potential risks of bleeding and conversion to laparotomy. Carboprost is a synthetic prostaglandin analogue, used widely in the management of obstetric haemorrhage, with its main mode of action being myometrial contractions. We present a series of four cases where intramyometrial carboprost injection was used successfully, prior to the laparoscopic resection of cornual ectopic pregnancies, to produce consistent and reproducible surgical benefits including prolonged myometrial contractions and subsequent reduced uterine blood flow. This results in a significant reduction in intraoperative blood loss as well as a clearer demarcation of the ectopic pregnancy and a technically easier resection.

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Pulmonary edema: a complication of local injection of vasopressin at laparoscopy

Cited by 71 publications

References 5 publications

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

A single dose of misoprostol for reducing hemorrhage during myomectomy: a randomized clinical trial

A new technique in the laparoscopic resection of cornual ectopic pregnancies: a case series

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