Risk of vasopressin use: a case of acute pulmonary oedema, post intramyometrial infiltration of vasopressin in laparoscopic myomectomy

Abstract

A 34-year-old patient underwent a laparoscopic myomectomy, complicated by a profound episode of bradycardia and hypotension following intramyometrial infiltration of vasopressin (20 IU), promptly corrected with intravenous ephedrine (6 mg) and glycopyrrolate (200 µg). At extubation, pink frothy fluid was noted in the endotracheal tube; she was visibly distressed, desaturated to 89% in air and was coughing up pink stained fluid. Acute pulmonary oedema secondary to vasopressin was suspected. A tight-fitting oxygen mask (100%) with positive end expiratory pressure was applied and intravenous furosemide (20 mg) and diamorphine (4 mg, 1 mg increments) were administered to facilitate diuresis and oxygenation. Chest X-ray confirmed acute pulmonary oedema. Arterial blood gas demonstrated type 2 respiratory failure. Over 12 hours, the oxygen was weaned to 1 L/min. She demonstrated excellent diuresis. Troponin and brain-natriuretic peptide were elevated, but echocardiogram was normal. The cardiology diagnosis was vasopressin-induced coronary vasospasm, precipitating acute pulmonary oedema. She was discharged home on day 5.

Misoprostol for open myomectomy: a systematic review and meta‐analysis of randomised control trials

“…It is important to note that the evidence for vasopressin as a single agent is limited compared with that of misoprostol and is based on a single RCT of 20 patients conducted in 1994 which showed a reduction in blood loss of 450 ml but no reduction in the need for blood transfusion 32 . The serious side effects of vasopressin (bronchospasm, cardiac arrest, angina and fluid imbalance) 33 which must be balanced against any haemorrhage‐reducing benefit, have resulted in its prohibition for use at myomectomy in some European countries.…”

Sudden bradycardia and impending cardiac arrest by intra-myometrial vasopressin in laparoscopic myomectomy: a case report and review of literature

“…Barcroft et al reported a case of acute pulmonary edema which developed in a case of laparoscopic myomectomy after infiltration of 20 U of vasopressin. 1 This case initially developed bradycardia and hypotension which was managed with glycopyrrolate, ephedrine and crystalloids. The patient settled down but at extubation was found to have pink frothy sputum and desaturated to 89% suggesting that she developed acute pulmonary edema.…”

“…Although intra-myometrial vasopressin results in very good surgical hemostasis it may cause adverse cardiac events like bradycardia, arrhythmia, cardiac arrest and pulmonary oedema and lethal catastrophe if not diagnosed and managed soon. [1][2][3][4] We report a case of successful resuscitation following bradycardia and impending cardiac arrest by intra-myometrial injection of vasopressin in a case of laparoscopic myomectomy.…”

Arginine vasopressin and pathophysiology of COVID-19: An innovative perspective

“…Notably, AVP triggers MAPK-induced endothelial dysfunction with direct effect for release of clotting factors [59] , [60] . Remarkably, administration of AVP reduces development of ALI [61] however, Barcroft et al, illustrated in a case-report study that intramyometrial infiltration of AVP during laparoscopic myomyectomy leads to acute pulmonary edema and coronary vasospasm [62] . Thus, dose-dependent effect of AVP may affect the cardiopulomary outcomes.…”