pituitrin and Blood-Loss--Surgical

Minimizing intraoperative blood loss during hysterectomy is crucial to lessen associated perioperative morbidity. The aim of this investigation is to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that compared vasopressin versus normal saline in controlling intraoperative blood loss during hysterectomy.. We screened 5 major databases (PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials) from inception till July 18, 2021. We used the following query search in all databases: (vasopressin OR arginine vasopressin OR argipressin OR antidiuretic hormone) AND (hysterectomy) AND (saline OR placebo OR control OR no treatment) AND (randomized OR randomised OR randomly). There was no language restriction during database screening.. We considered all studies that met the following evidence-based criteria: (1) patients: individuals undergoing hysterectomy for any indication, (2) intervention: vasopressin, (3) comparator: normal saline, placebo, or no treatment, (4) outcomes: reliable extraction of any of our endpoints, and (5) study design: RCTs. We assessed risk of bias of included studies and pooled endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). We performed statistical analysis using the Review Manager software, version 5.4.0.. Seven RCTs with an overall low risk of bias met the inclusion criteria. This meta-analysis included a total of 455 patients; 232 and 223 patients were allocated to vasopressin and control group, respectively. The majority of RCTs were vaginal hysterectomy (n = 5), few abdominal hysterectomy, (n = 2) and no laparoscopic hysterectomy. The mean estimated intraoperative blood loss was significantly lower in favor of the vasopressin group compared with the control group (n = 6 RCTs, MD = -119.85 mL, 95% CI [-177.55, -62.14], p <.001). However, there was no significant difference between both groups regarding mean operating time, mean change in postoperative hemoglobin, mean hospital stay, rate of febrile morbidity, rate of pelvic infection, rate of perioperative blood transfusion, and rate of perioperative complications.. Compared with normal saline, vasopressin significantly reduced the estimated blood loss during hysterectomy but did not change any clinically significant outcomes. In addition, vasopressin was safe and did not correlate with an increase in the rates of febrile morbidity or pelvic infection.

Topics: Blood Loss, Surgical; Female; Humans; Hysterectomy; Hysterectomy, Vaginal; Randomized Controlled Trials as Topic; Vasopressins

To collate evidence from randomized controlled trials (RCTs) and nonrandomized controlled trials (NCTs) on the efficacy and safety of vasopressin versus passive control (placebo/no treatment) during myomectomy.. Six information sources were screened until 25-June-2022. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to evaluate the risk of bias. Data were summarized as mean difference or risk ratio with 95% confidence interval in a random-effects model.. Eleven studies, comprising 1067 patients (vasopressin=567 and control=500) were analyzed. For RCTs (n = 8), the overall quality included 'high risk' (n = 4), 'low risk' (n = 2), and 'some concerns' (n = 2). For NCTs (n = 3), the overall quality included 'good' (n = 2) and 'fair' (n = 1). The mean intraoperative blood loss, mean difference in hemoglobin level, mean difference in hematocrit level, rate of perioperative blood transfusion, and mean operative time were significantly reduced in favor of the vasopressin group compared with the control group. However, there was no significant difference between both groups regarding the mean hospital stay. Pertaining to safety endpoints, after omission of an outlier study, the rate of drug-related cardiovascular adverse events did not significantly differ between both groups. There was no quantitative evidence of publication bias for the endpoint of intraoperative blood loss.. Among patients undergoing myomectomy, prophylactic administration of vasopressin was largely safe and correlated with significant reductions in intraoperative blood loss and associated morbidities compared with a passive control intervention. Nonetheless, the conclusions should be cautiously interpreted owing to the low-evidence quality and the used doses varied greatly between studies.

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Morbidity; Randomized Controlled Trials as Topic; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Open myomectomy is the most adopted surgical strategy in the conservative treatment of uterine fibroids. According to several studies, the likelihood that a woman could develop uterine myomas is estimated around 75% by the age of 50. Open myomectomy is nonetheless a complicated surgery in terms of blood loss and need for transfusion. Many strategies have been published with the aim of limiting intra and post-operative bleeding complications. The scope of this review is to describe in detail the different techniques reported in literature focusing on their validity and safety.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Female; Gonadotropin-Releasing Hormone; Hemostasis, Surgical; Hemostatics; Humans; Leiomyoma; Ligation; Operative Blood Salvage; Oxytocics; Oxytocin; Tourniquets; Tranexamic Acid; Uterine Artery; Uterine Artery Embolization; Uterine Neoplasms; Vasopressins

Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Surgical treatments for CIN are commonly associated with blood loss.. To assess the effectiveness and safety of interventions for preventing blood loss during the treatment of CIN.. We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE and CENTRAL up to November 2012. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies.. Randomised controlled trials (RCTs) of vasopressin, tranexamic acid, haemostatic sutures, Amino-Cerv or Monsel's solution in women undergoing surgery for CIN.. Two reviewers independently abstracted data and assessed risk of bias. Risk ratios comparing adverse events in women who received one of the interventions were pooled in a random-effects meta-analyses or included in single trial analyses.. Twelve RCTs (N = 1602, of whom 1512 were assessed) were included.Vasopressin significantly reduced perioperative bleeding (mean difference (MD) = -100.80, 95% confidence interval (CI) -129.48 to -72.12) and was associated with a decreased risk of bleeding that required haemostatic sutures or further vasopressin, compared to placebo (risk ratio (RR) = 0.39, 95% CI 0.27 to 0.56).Tranexamic acid significantly reduced risk of secondary haemorrhage (RR = 0.23, 95% CI 0.11 to 0.50), but not primary haemorrhage (RR = 1.24, 95% CI 0.04 to 38.23) after knife and laser cone biopsy, compared with placebo. There was also a statistically significant reduction in postoperative blood loss compared with placebo (MD = -55.60, 95% CI -94.91 to -16.29).Packing with Monsel's solution resulted in less perioperative blood loss (MD = -22.00, 95% CI -23.09 to -20.91) and decreased the risk of dysmenorrhoea (RR = 0.37, 95% CI 0.16 to 0.84), unsatisfactory colposcopy (RR = 0.43, 95% CI 0.30 to 0.63) and cervical stenosis (RR = 0.35, 95% CI 0.25 to 0.49) compared to routine suturing, but was not statistically different to sutures for risk of primary and secondary haemorrhages.Amino-Cerv antibiotic gel failed to make a difference on secondary haemorrhage but was associated with significantly less vaginal discharge at 2 weeks compared with routine care (RR = 0.27, 95% CI 0.09 to 0.86).There was no significant difference in blood loss between women who received ball electrode diathermy and those who received Monsel's paste (MD = 4.82, 95% CI -3.45 to 13.09).. Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, used in combination with local anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are insufficient data to assess the effects on primary haemorrhage. There is some evidence that haemostatic suturing has an adverse effect on blood loss, cervical stenosis and satisfactory colposcopy.

Topics: Blood Loss, Surgical; Female; Ferric Compounds; Hemostasis, Surgical; Hemostatics; Humans; Inositol; Methionine; Randomized Controlled Trials as Topic; Sulfates; Sutures; Tranexamic Acid; Urea; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vaginal Creams, Foams, and Jellies; Vasopressins

Recent technological advances in endoscopy have allowed gynecological surgeons to expand the operative approaches that can be utilized in the conservative management of uterine myomas. Commonly used approaches in gynecological practice now include laparoscopic myomectomy, laparoscopic-assisted myomectomy through a mini-laparotomy incision and robotic-assisted laparoscopic myomectomy. Adequate preoperative evaluation with careful selection of the best operative approach for each particular patient constitutes the basis of safe and effective surgery for the operative management of uterine myomas.

Topics: Blood Loss, Surgical; Disease Management; Endoscopy; Female; Humans; Hysteroscopy; Laparoscopy; Laparotomy; Leiomyoma; Length of Stay; Minimally Invasive Surgical Procedures; Multicenter Studies as Topic; Preoperative Care; Randomized Controlled Trials as Topic; Retrospective Studies; Robotics; Surgery, Computer-Assisted; Sutures; Uterine Neoplasms; Vasopressins

Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Surgical treatments for CIN are commonly associated with blood loss.. To assess the effectiveness and safety of interventions for preventing blood loss during the treatment of CIN.. We searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE and CENTRAL up to April 2009. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies.. Randomised controlled trials (RCTs) of vasopressin, tranexamic acid, haemostatic sutures, Amino-Cerv or Monsel's solution in women undergoing surgery for CIN.. Two reviewers independently abstracted data and assessed risk of bias. Risk ratios comparing adverse events in women who received one of the interventions were pooled in a random-effects meta-analyses or included in single trial analyses.. Twelve RCTs (N = 1602, of whom 1512 were assessed) were included.Vasopressin significantly reduced perioperative bleeding (mean difference (MD) = -100.80, 95% confidence interval (CI) -129.48 to -72.12) and was associated with a decreased risk of bleeding that required haemostatic sutures or further vasopressin, compared to placebo (risk ratio (RR) = 0.39, 95% CI 0.27 to 0.56).Tranexamic acid significantly reduced risk of secondary haemorrhage (RR = 0.23, 95% CI 0.11 to 0.50), but not primary haemorrhage (RR = 1.24, 95% CI 0.04 to 38.23) after knife and laser cone biopsy, compared with placebo. There was also a statistically significant reduction in postoperative blood loss compared with placebo (MD = -55.60, 95% CI -94.91 to -16.29).Packing with Monsel's solution resulted in less perioperative blood loss (MD = -22.00, 95% CI -23.09 to -20.91) and decreased the risk of dysmenorrhoea (RR = 0.37, 95% CI 0.16 to 0.84), unsatisfactory colposcopy (RR = 0.43, 95% CI 0.30 to 0.63) and cervical stenosis (RR = 0.35, 95% CI 0.25 to 0.49) compared to routine suturing, but was not statistically different to sutures for risk of primary and secondary haemorrhages.Amino-Cerv antibiotic gel failed to make a difference on secondary haemorrhage but was associated with significantly less vaginal discharge at 2 weeks compared with routine care (RR = 0.27, 95% CI 0.09 to 0.86).There was no significant difference in blood loss between women who received ball electrode diathermy and those who received Monsel's paste (MD = 4.82, 95% CI -3.45 to 13.09).. Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, used in combination with local anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are insufficient data to assess the effects on primary haemorrhage. There is some evidence that haemostatic suturing has an adverse effect on blood loss, cervical stenosis and satisfactory colposcopy.

Topics: Blood Loss, Surgical; Female; Ferric Compounds; Hemostasis, Surgical; Hemostatics; Humans; Randomized Controlled Trials as Topic; Sulfates; Sutures; Tranexamic Acid; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vasopressins

To assess the effectiveness and safety of interventions to reduce blood loss during myomectomy.. Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, between 1966 and 2006 for randomized controlled trials (RCTs).. We found significant reductions in blood loss with vaginal misoprostol (weighted mean difference [WMD] -149.00 mL, 95% confidence interval [CI] -229.24 to -68.76); intramyometrial vasopressin and analogues (WMD -298.72 mL, 95% CI -593.10 to -4.34); intramyometrial bupivacaine plus epinephrine (WMD -68.60 mL, 95% CI -93.69 to -43.51); and pericervical tourniquet (WMD -1870.00 mL, 95% CI -2547.16 to -1192.84). There was no evidence of effect in blood loss with myoma enucleation by morcellation and oxytocin.. There is limited evidence from a few RCTs that some interventions may reduce bleeding during myomectomy. There is need for adequately powered RCTs to shed more light on the effectiveness, safety, and cost of different interventions to reduce blood loss during myomectomy.

Topics: Blood Loss, Surgical; Bupivacaine; Combined Modality Therapy; Female; Gynecologic Surgical Procedures; Humans; Leiomyomatosis; Misoprostol; Oxytocin; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

Good surgical technique and other interventions can reduce immediate and long-term blood loss which is a common complication of surgery for cervical intra-epithelial neoplasia. The objective of this review was to assess the effect of interventions to reduce blood loss due to surgery for cervical intra-epithelial neoplasia.. We searched the Cochrane Gynaecological Cancer Group trials register.. Randomised and quasi-randomised trials of vasopressin, tranexamic acid, haemostatic sutures or Monsel's solution in women who have had surgery for intra-epithelial neoplasia.. Two reviewers independently abstracted data.. Seven trials were included. Vasopressin had a beneficial effect on peri-operative bleeding. Prophylactic tranexamic acid reduced haemorrhage after knife and laser cone biopsy. Packing with Monsel's solution resulted in less peri-operative blood loss and secondary haemorrhages than routine suturing. Elective suturing also appeared to increase the risk of amenorrhoea and dysmenorrhoea. Vaginal packing increased satisfactory colposcopy rates at follow-up and reduced post-surgical stenosis.. Bleeding associated with surgery of the cervix appears to be reduced by vasopressin, which is used under local rather than general anaesthetic. Tranexamic acid appears to be beneficial after knife and laser cone biopsy. There are not enough data to assess the effects on primary haemorrhage. There is some evidence that haemostatic suturing has an adverse effect on blood loss, cervical stenosis and satisfactory colposcopy.

Topics: Blood Loss, Surgical; Female; Ferric Compounds; Hemostasis, Surgical; Hemostatics; Humans; Sulfates; Sutures; Tranexamic Acid; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vasopressins

Topics: Adolescent; Blood Group Incompatibility; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Child; Child, Preschool; Disease Transmission, Infectious; Erythropoietin; Female; Humans; Infant; Male; Orthopedics; Patient Care Planning; Transfusion Reaction; Vasopressins

Topics: Anesthesia; Blood Loss, Surgical; Blood Substitutes; Blood Transfusion; Blood Transfusion, Autologous; Christianity; Deamino Arginine Vasopressin; Decision Making; Emergencies; Hematocrit; Hemodilution; Hemodynamics; Hemoglobins; Humans; Intraoperative Care; Oxygen; Surgical Procedures, Operative; Transfusion Reaction; Vasopressins

Even though the injection of diluted vasopressin into the uterus is expected to reduce intraoperative bleeding with decreased adverse effects during robot-assisted laparoscopic myomectomy (RALM), there is a lack of relevant trials to show its effect and safety. Thus, this study was designed to compare the effect and safety of vasopressin injection on bleedings based on dilution levels of vasopressin with constant volumes during RALM.. This is a randomised controlled pilot trial, where a total of 39 patients will be randomly divided into three experimental groups in a 1:1:1 ratio. All patients will be classified into the three groups based on the dilution level of vasopressin: group 1-a solution prepared by mixing 20 units of vasopressin with 100 mL of normal saline to make a total of 100 mL; group 2-a solution prepared by mixing 20 units of vasopressin with 200 mL of normal saline to make a total of 100 mL and group 3-a solution prepared by mixing 20 units of vasopressin with 400 mL of normal saline to make a total of 100 mL. During RALM, we will inject diluted vasopressin at different concentrations with a total of 100 mL. As the primary endpoint, estimated blood loss would be compared. As secondary endpoints, we will check the level of haemoglobin and haematocrit, operation time, amount of transfusion, and the period of hospitalisation. In addition, we will check other complications related to vasopressin injection.. This pilot study has been approved by the Institutional Review Board of the Seoul National University Hospital (No. H-2011-107-1174). All potential subjects will be provided written informed consent. The results of this study will be published in peer-reviewed journals and be presented at academic conferences.. NCT04874246 and CKCT0006225.

Topics: Blood Loss, Surgical; Female; Hemoglobins; Humans; Laparoscopy; Pilot Projects; Randomized Controlled Trials as Topic; Robotics; Saline Solution; Uterine Myomectomy; Vasopressins

To compare the efficacy and safety of intramyometrial vasopressin plus rectal misoprostol with intramyometrial vasopressin alone to reduce blood loss during laparoscopic myomectomy.. A randomized, single-blind, controlled trial was conducted at All India Institute of Medical Sciences, New Delhi, India. Sixty women with symptomatic leiomyoma scheduled for laparoscopic myomectomy were recruited for the study. Thirty women received intramyometrial vasopressin plus rectal misoprostol (30 min before procedure) (Group I) and 30 women received intramyometrial vasopressin alone (Group II) during laparoscopic myomectomy. The primary outcome measure was intra-operative blood loss during surgery. Secondary outcome measures included decrease in postoperative haemoglobin, ease of enucleation of myomas, duration of surgery, need for additional haemostatic measures or blood transfusion, intra- and postoperative morbidity, and duration of hospital stay.. The baseline demographic features and characteristics of leiomyomas were comparable in both groups. The mean (±standard deviation) blood loss in Group I was 139 ± 96.7 ml, which was significantly less than that for Group II (206 ± 101.2 ml) (p = 0.008). The mean postoperative haemoglobin was 11.6 ± 1.3 g/dl in Group I and 10.0 ± 1.2 g/dl in Group II (p = 0.001). Although blood loss was not clinically significant in either group, the decrease in haemoglobin was significantly higher in Group II. The mean score for ease of enucleation (surgeon-rated measure) was significantly lower in Group I (2.6 ± 1.1) compared with Group II (3.4 ± 1.1) (p = 0.029). Intra- and postoperative vital signs, duration of surgery, need for blood transfusion and postoperative morbidity were comparable in both groups.. The addition of rectal misoprostol to intramyometrial vasopressin led to a significant reduction in blood loss and decreased the postoperative drop in haemoglobin. The combination also improved the ease of enucleation of myomas.

Topics: Administration, Rectal; Adolescent; Adult; Blood Loss, Surgical; Hemostatics; Humans; Laparoscopy; Misoprostol; Oxytocics; Uterine Myomectomy; Vasopressins; Young Adult

To determine if higher-volume, fixed-dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy.. Randomised multicentre clinical trial.. Tertiary-care academic centres in the USA.. Women undergoing conventional laparoscopic or robot-assisted laparoscopic myomectomy.. All participants received the same 10-unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline).. The primary study outcome was estimated blood loss; the study was powered to detect a 100-ml difference.. A total of 152 women were randomised; 76 patients in each group. Baseline demographics were similar between groups. The primary outcome of intraoperative blood loss was not significantly different, as measured by three parameters: surgeon estimate (mean estimated blood loss 178 ± 265 ml and 198 ± 232 ml, dilute and concentrated groups respectively, P = 0.65), suction canister-calculated blood loss, or change in haematocrit levels. There were no vasopressin-related adverse events.. Both dilute and concentrated vasopressin solutions that use the same drug dosing demonstrate comparable safety and tolerability when administered for minimally invasive myomectomy; however, higher volume administration of vasopressin does not reduce blood loss.. This randomised trial failed to show benefit of high-volume dilute vasopression.

Topics: Adult; Blood Loss, Surgical; Female; Hemostasis, Surgical; Hemostatics; Humans; Laparoscopy; Leiomyoma; Middle Aged; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Although hydroxyethyl starch (HES) is commonly used as an intravascular volume expander in surgical patients, recent studies suggest that it may increase the risk of renal failure in critically ill patients. We hypothesized that patients undergoing radical prostatectomy and receiving HES would be more likely to develop markers of renal failure, such as increasing urinary neutrophil gelatinase-associated lipocalin (u-NGAL), creatinine clearance (C(crea)), and decreasing urine output (UO).. In a randomized, double-blinded, placebo-controlled study, 40 patients referred for radical prostatectomy received either 6% HES 130/0.4 or saline 0.9%; 7.5 mL/kg during the first hour of surgery and 5 mL/kg in the following hours; u-NGAL, urine albumin, C(crea), UO, arterial blood pressure, and plasma concentrations of creatinine, renin, angiotensin II, aldosterone, and vasopressin were measured before, during, and after surgery.. Thirty-six patients completed the study. u-NGAL, C(crea), UO, plasma neutrophil gelatinase-associated lipocalin, p-creatinine, urine albumin, and arterial blood pressure were the same in both groups. Blood loss was higher in the HES group (HES 1250 vs saline 750 mL), while p-albumin was reduced to a significantly lower level. P-renin and p-angiotensin-II increased in both groups, whereas p-aldosterone and p-vasopressin increased significantly in the saline group.. We found no evidence of nephrotoxicity after infusion of 6% HES 130/0.4 in patients undergoing prostatectomy with normal preoperative renal function. Hemodynamic stability and infused fluid volume were the same in both groups. We observed an increased blood loss in the group given 6% HES 130/0.4.

Topics: Acute-Phase Proteins; Aged; Albuminuria; Aldosterone; Angiotensin II; Arterial Pressure; Biomarkers; Blood Loss, Surgical; Creatinine; Denmark; Double-Blind Method; Fluid Therapy; Humans; Hydroxyethyl Starch Derivatives; Kidney; Lipocalin-2; Lipocalins; Male; Middle Aged; Plasma Substitutes; Prostatectomy; Proto-Oncogene Proteins; Renin; Renin-Angiotensin System; Time Factors; Treatment Outcome; Vasopressins

To compare the effectiveness and safety of vasopressin with epinephrine for reducing blood loss during laparoscopic myomectomy.. Sixty patients undergoing laparoscopic myomectomy were allocated at random to receive either dilute vasopressin or epinephrine into the serosal and/or overlying myometrium, and just around the myoma. The surgeon was blinded to the group allocation. Blood loss, duration of surgery, degree of surgical difficulty, postoperative pain scores and complications were compared.. Patient characteristics (e.g. age, body mass index, demographic data), number of myomas, and location and size of the largest myoma were similar between the two study groups. There were no differences in operative blood loss, operative time, subjective surgical difficulty or postoperative pain between the two groups. Transient and non-serious increases in systolic and diastolic blood pressure and heart rate following intra-operative intramyometrial and/or perimyometrial injection of the vasoconstrictive agent only occurred in the epinephrine group, but the difference between the groups was not significant (13% vs 0%, p=0.112). No significant postoperative complications were observed in either group.. Injection of dilute epinephrine before laparoscopic myomectomy was comparable to injection of dilute vasopressin in terms of operative blood loss, operative time, subjective surgical difficulty, postoperative pain and complications.

Topics: Adult; Blood Loss, Surgical; Epinephrine; Female; Humans; Laparoscopy; Leiomyoma; Middle Aged; Neoplasms, Multiple Primary; Uterine Hemorrhage; Uterine Myomectomy; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

To evaluate the efficacy of transcervical intralesional vasopressin injection to submucous myoma in hysteroscopic myomectomy from 2011 to 2014.. This was a prospective, randomized, double-blind study in a single center. Forty premenopausal women with symptomatic submucous myoma requiring hysteroscopic myomectomy were randomized to transcervical intralesional vasopressin injection or placebo in a 4:4 ratio. The primary outcome was operative time. Secondary outcomes including fluid volumes, blood loss, and visual clarity were compared between the two groups.. The median duration for myomectomy was 19.9 minutes (range 3.1-54.2 minutes) in the vasopressin group compared with 29.0 minutes (range 8.0-60.9 minutes) in the placebo group, a nonsignificant difference (P=.14). There were significant reductions in the median volume of fluid used (4,200 mL [range 1,300-21,000 mL] compared with 9,800 mL (range 1,500-23,000 mL; P=.004) and fluid intravasation (0 mL [range 0-3,100] compared with 300 mL [range -150-3,150 mL; P=.029) in the vasopressin group. The median intraoperative blood loss was reduced (5 mL [range 1-50 mL] compared with 20 mL [range 1-150 mL; P=.002). The operative surgeon rated that 95% of the vasopressin group had "minimal" bleeding compared with 36.8% in the placebo group. The surgical field (visual analog scale [VAS] 9 [range 2-10] compared with 6 [range 2-10; P<.001]; 0=worst visual clarity, 10=best visual clarity) and the effluent fluid (VAS 1 [range 0-7] compared with 4 [range 0-8; P<.001]; 0=clear, 10=unclear) were statistically significantly clearer in the vasopressin group.. Transcervical intralesional vasopressin injection in hysteroscopic myomectomy did not reduce operative time but did reduce volume of inflow fluid, fluid intravasation, intraoperative blood loss, and improving visual clarity.. Centre for Clinical Research and Biostatistics, http://www.cct.cuhk.edu.hk/Registry/publictriallist.aspx, CUHK_CCT00291.

Topics: Adult; Blood Loss, Surgical; Cervix Uteri; Double-Blind Method; Female; Humans; Hysteroscopy; Injections, Intralesional; Leiomyoma; Middle Aged; Prospective Studies; Time Factors; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

To compare the efficacy of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone as hemostatic agents for the reduction of blood loss during myomectomies.. Prospective, randomized, double-blind, controlled study.. University of the West Indies and Andrews Memorial Hospital.. Fifty women with symptomatic uterine fibroids, 25 receiving misoprostol and vasopressin and 25 receiving vasopressin alone before myomectomy.. Abdominal myomectomies on patients with symptomatic uterine fibroids.. Perioperative blood loss and febrile morbidity.. There were no statistically significant differences in sociodemographic, clinical, or myoma characteristics between the two groups at baseline. Postoperatively, there were no statistically significant differences in perioperative febrile morbidity or blood pressure between the groups. However, the group treated with misoprostol plus vasopressin had statistically significantly lower blood loss (geometric mean with 95% confidence interval, 334 mL [261 to 428] vs. 623 mL [354 to 1,094], a smaller change in hemoglobin (1.6 ± 1.5 vs. 3.0 ± 2.0), and a lower requirement for transfusion. In addition to treatment, significant determinants of blood loss were larger size of fibroids and greater number of fibroids.. We conclude that perivascular vasopressin plus misoprostol caused a significant reduction in blood loss compared with perivascular vasopressin alone.. NCT01700478.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Drug Therapy, Combination; Female; Hemostatic Techniques; Hemostatics; Humans; Jamaica; Leiomyoma; Misoprostol; Prospective Studies; Time Factors; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

To determine whether injecting the colpotomy wound with diluted vasopressin decreases vaginal bleeding after laparoscopically assisted vaginal hysterectomy (LAVH).. In this prospective controlled study 100 patients who underwent LAVH from July 1, 2005 to June 30, 2007, were randomized to receive an injection of vasopressin (n=50) or normal saline (n=50) solution in the colpotomy wound.. In the vasopressin group, bleeding from the colpotomy wound occurred for more than 7 days in 9 patients (18%), and none was bleeding after 1 month; in the control group, the corresponding values were 29 (58%) and 2 (4%). Compared with the study group, the control group had a significantly higher rate of chronic bleeding from the colpotomy wound for more than 7 days and for more than 14 days after LAVH (P<0.001 for both).. Infiltrating the colpotomy wound with diluted vasopressin was found to prevent chronic vaginal bleeding, which frequently occurs following LAVH.

Topics: Blood Loss, Surgical; Colpotomy; Female; Hemostatics; Humans; Hysterectomy, Vaginal; Injections, Intralesional; Laparoscopy; Prospective Studies; Vasopressins

To compare blood loss, operative time, postoperative pain medication requirements, and complication rates in patients undergoing vaginal hysterectomy who were randomly assigned to receive preoperative intracervical vasopressin or no intracervical injection.. Fifty-eight women undergoing vaginal hysterectomy were randomly allocated to receive either eight units of vasopressin intracervically or nothing preoperative from January 2004 to January 2005. A researcher blinded to the study group determined blood loss. The surgeries were performed using uniform steps by senior residents under the direction of two attending surgeons. Multiple preoperative and postoperative values were evaluated, including time to specific points in surgery and use of postoperative pain medication. Independent sample t tests, Fisher exact test, and Pearson chi tests were used to analyze the data.. The two groups were similar in terms of age, weight, parity, and ethnicity. There was also no difference in indication for surgery or estimated uterine size. The vasopressin group lost significantly less blood (145.3 mL compared with 266.4 mL control; P=.022). There was a significant difference in the increase in mean blood pressure at 5 minutes after injection (10.4 for the vasopressin group compared with. 2.5 for the control group, P=.043). There was no significant difference in immediate recovery room morphine requirements, but patient-controlled anesthesia usage was significantly higher in the vasopressin group.. The preoperative injection of intracervical vasopressin leads to decreased blood loss during vaginal hysterectomy. There was, however, a significant increase in postoperative morphine use in patients receiving vasopressin.. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00799292. I.

Topics: Adult; Blood Loss, Surgical; Cervix Uteri; Female; Humans; Hysterectomy, Vaginal; Injections; Middle Aged; Pain, Postoperative; Premedication; Preoperative Care; Time Factors; Vasoconstrictor Agents; Vasopressins

This study was undertaken to determine whether vasopressin decreases uterine artery blood flow and blood loss in early second-trimester surgical abortions (dilation and evacuation).. Randomized, double blind, placebo-controlled trial of a saline paracervical block with or without vasopressin before dilation and evacuation. Uterine artery pulsatility index and blood loss were measured.. Demographics were similar in both groups (mean gestational age 16.8 weeks, SD 1.7). Of 35 randomly assigned patients, Doppler waveforms were adequate in 28 patients (vasopressin, n = 13; placebo, n = 15). The mean difference in uterine artery pulsatility index before and after injection between groups was not significantly different (P = .14). Procedural blood loss was no different.. Paracervical vasopressin compared to placebo injection did not result in significant changes in uterine artery pulsatility index in early second-trimester dilation and evacuation procedures.

Topics: Abortion, Induced; Adult; Arteries; Blood Loss, Surgical; Double-Blind Method; Female; Hemostasis, Surgical; Humans; Pregnancy; Regional Blood Flow; Uterus; Vasoconstrictor Agents; Vasopressins

To investigate if the use of vasopressin during abdominal hysterectomy would decrease blood loss.. Fifty-one patients undergoing abdominal hysterectomy with the diagnosis of leiomyomatous uterus were randomized and received either vasopressin 10 units/10 mL of normal saline or 10 mL of normal saline, injected 5 mL bilaterally, 1 cm medial to the uterine vessels into the lower uterine segment. The sample size was determined assuming a one-third reduction in total blood loss would be clinically relevant. A power analysis determined that 25 patients would be required in each group to assure a power of 0.80, at the.05 significance level.. Overall, the two groups were very similar with regard to their demographics, preoperative diagnosis, and relevant findings at the time of surgery. The mean total blood loss in the vasopressin and placebo groups was 445.41 mL and 748.42 mL, respectively. Total blood loss was significantly decreased by 40% in the vasopressin group compared with the placebo group (P <.001). There was no statistically significant difference between the two groups with respect to possible confounding variables or surgical complications.. Injection of vasopressin into the uterus at the time of abdominal hysterectomy significantly reduces blood loss without increasing morbidity. We have shown that it is a useful adjunct during abdominal hysterectomy.

Topics: Adolescent; Adult; Blood Loss, Surgical; Female; Follow-Up Studies; Humans; Hysterectomy; Injections, Intralesional; Leiomyoma; Middle Aged; Probability; Reference Values; Sampling Studies; Treatment Outcome; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

The purpose of this study was to evaluate the risk of pelvic infection with the use of vasopressin at time of vaginal hysterectomy with a randomized controlled trial.. Women who underwent vaginal hysterectomy and agreed to participate were randomly assigned to pericervical injections of vasopressin or normal saline solution. Surgeons and patients were blinded to the injected substance. Power analysis revealed that a sample size of 116 patients would be sufficient to detect a 4-fold difference in pelvic infection rates between the 2 groups, with 90% power and a probability value of.05.. Analysis with 117 patients found no difference in infection rate between the normal saline solution group and the vasopressin groups (7.3% vs 1.6%; P =.19). Estimated blood loss (312 +/- 222 mL vs 446 +/- 296 mL; P =.006) and change in hemoglobin and hematocrit levels (2.1 +/- 1.4 gm vs 2.9 +/- 1.4 gm; P: =.02; and 6.7% +/- 3.4% vs 8.5% +/- 3.8%; P =.01; vasopressin versus normal saline solution, respectively) were significantly less in the vasopressin group. There were no significant differences in interval blood pressure measurements after vasopressin administration between the 2 groups.. The use of vasopressin during vaginal hysterectomy does not increase the risk of pelvic infection, does decrease operative blood loss, and does not significantly affect blood pressure.

Topics: Adult; Blood Loss, Surgical; Blood Pressure; Cervix Uteri; Double-Blind Method; Female; Gynecologic Surgical Procedures; Humans; Injections; Middle Aged; Placebos; Risk Factors; Sodium Chloride; Surgical Wound Infection; Vasopressins

To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy.. Between March 1994 and February 1995, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial comparing vasopressin (26 patients) and tourniquet (26 patients) for hemostasis. Myomectomy was performed after either the perivascular injection of 20 U of vasopressin diluted to 20 mL with normal saline or with the use of a Foley catheter tourniquet around both uterine vessels. The efficacy of each method was measured by comparing differences in pre- and postoperative hemoglobin levels, intraoperative blood pressure, measured blood loss, need for blood transfusion, evidence of postoperative febrile morbidity, complications, and length of hospital stay.. Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195] versus 512.7 mL [SD 400] for tourniquet [P = .036]). Six of 26 patients in the tourniquet group lost more than 1000 mL of blood, whereas all of the vasopressin subjects lost less than this amount (P = .023). However, there were no significant differences between the two groups in the fall in the hemoglobin level, number of blood transfusions given, intraoperative blood pressure, highest postoperative pulse and temperature, or other complications.. Vasopressin prevents blood loss better than using the tourniquet during myomectomy.

Topics: Adult; Blood Loss, Surgical; Blood Pressure; Blood Transfusion; Female; Hemoglobins; Hemostasis, Surgical; Humans; Leiomyoma; Middle Aged; Postoperative Complications; Tourniquets; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Blood Loss, Surgical; Female; Hemostasis, Surgical; Hemostatics; Humans; Leiomyoma; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

To assess the effect of intracervical injection of dilute (0.05 U/mL) vasopressin solution on blood loss during operative hysteroscopy.. In a randomized, double-blind study, dilute vasopressin solution or placebo (normal saline) was injected into the cervical stroma of 106 women before dilation of the cervix in preparation for operative hysteroscopy. Intraoperative bleeding was calculated by dividing the number of red blood cells per milliliter of outflow distention fluid by the number of red blood cells per milliliter of the woman's blood immediately before the procedure and multiplying this quotient by the total amount of outflow fluid collected. Pressures were kept constant with a hysteroscopic infusion pump.. The mean (+/-standard error of the mean) intraoperative blood loss of the treated (vasopressin) and control (placebo) groups was 20.3 +/- 4.1 mL (range 0-135) and 33.4 +/- 5.4 mL (range 0-290), respectively. The volume of distention fluid intravasation in the treated and control groups was 448.5 +/- 47.0 mL (range 30-1410) and 819.1 +/- 79.7 mL (range 20-1977), respectively. The operating time in the treated and control groups was 31.1 +/- 1.2 minutes (range 18-52) and 34.1 +/- 1.3 minutes (range 19-65), respectively. For all three outcome measures, the differences between the two groups were statistically significant, but for visual clarity of the uterine cavity during surgery, the difference was not significant.. Administration of dilute vasopressin solution (0.05 U/mL) to the cervical stroma significantly reduces blood loss, distention fluid intravasation, and operative time during hysteroscopy. Further evaluation is required to determine the optimum dosage.

Topics: Adult; Blood Loss, Surgical; Double-Blind Method; Endoscopy; Female; Hemodynamics; Hemostatics; Humans; Hysteroscopy; Leiomyoma; Middle Aged; Uterine Neoplasms; Uterus; Vasopressins

Desmopressin (1-deamino-8-D-argininevasopressin, DDAVP) is a synthetic analog of the antidiuretic hormone L-argininevasopressin. DDAVP has been shown to increase the plasma concentration of endothelial factor VIII, thus increasing coagulant activity. There is evidence from controlled clinical trials indicating that DDAVP can reduce blood loss and transfusion requirements for individuals with normal coagulation profiles undergoing various surgical procedures. This study was conducted to evaluate the efficacy of the DDAVP in reduction of blood loss during orthognathic surgery. Twenty patients, 15 females and 5 males, undergoing bimaxillary osteotomy were randomized into two groups of ten. Perioperatively, group 1 patients received 20 micrograms of DDAVP infused over one-half hour. Group II patients did not receive DDAVP. Hypotensive anesthesia (mean arterial pressure < 60 mm Hg) was routinely employed for both groups. On average, the blood loss in group I patients was 144 ml less per patient than group II patients (p < 0.50). Only 2 of 10 patients in group I lost in excess of 750 ml, while 6 to 10 group II patients experienced blood loss greater than 750 ml (p < 0.20). The average postoperative hematocrit for patients in group I dropped by 6.17 of the preoperative mean hematocrit (p < 0.001). The average drop in hematocrits among the group II patients was 11.61 (p < 0.001). When collated, this hematocrit drop of 11.61 for group II and 6.17 for group I (recipients of DDAVP) proved to be significantly different (p < 0.01). It is concluded from this study that patients receiving a standard dose of DDAVP prior to bimaxillary osteotomy would experience reduced intraoperative blood loss, providing that blood pressure is well controlled and fluid replacement is carefully managed. No significant adverse side effects of desmopressin acetate were observed.

Topics: Blood Loss, Surgical; Deamino Arginine Vasopressin; Female; Hematocrit; Humans; Male; Maxilla; Partial Thromboplastin Time; Prothrombin Time; Random Allocation; Vasopressins

Topics: Blood Loss, Surgical; Humans; Injections, Intralesional; Male; Prostatectomy; Vasopressins

A study was performed to assess the effect of dilute vasopressin on intraoperative bleeding and intravasation of the medium during resectoscopic hysteroscopic surgery. Dilute vasopressin or placebo was injected into the cervical stroma at the commencement of resectoscopic endometrial ablation and/or submucous myomectomy in a prospective, computer-generated, double-blind, placebo study. The operator estimated the intraoperative bleeding. The inflow volume and outflow recovered volume of sorbitol, used as a distending medium, were recorded. Pressures were kept constant with a pump. Operating time was also recorded. In 64 women the mean inflow volume was 5,584 mL (range, 500-27,000), and the mean deficit (intravasation) was 311 mL (range, 0-2,100). The mean surgical time was 37.1 minutes (range, 11-120). The deficit volume was related to the duration of surgery (P = .001) and to total inflow volume (P = .001). Increased operating time and volume infused also increase intravasation. Multivariate analysis showed that patients receiving vasopressin had a 0.36 risk of intravasation (confidence limit, 0.14-0.91) as compared with the placebo. Vasopressin injected intracervically, in conjunction with resectoscopic intrauterine surgery, reduces but does not eliminate intravasation of the medium. It also decreases intraoperative bleeding.

Topics: Blood Loss, Surgical; Capillary Permeability; Cervix Uteri; Confidence Intervals; Double-Blind Method; Electrocoagulation; Female; Genitalia, Female; Humans; Hysteroscopy; Infusion Pumps; Injections; Intraoperative Complications; Multivariate Analysis; Prospective Studies; Regional Blood Flow; Treatment Outcome; Vasopressins

To assess the efficacy of intramyometrial vasopressin for minimising bleeding and its sequelae at myomectomy.. A randomised placebo controlled trial.. University Hospital of the West Indies, Kingston, Jamaica.. Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group.. Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline).. The efficacy of vasopressin was measured by comparing pre- and post-operative haemoglobin levels and haematocrit, changes in intra-operative pulse and blood pressure, measured blood loss, need for blood transfusion and post-operative febrile morbidity in the treatment and control groups.. The use of vasopressin resulted in median blood loss of 225 ml (range 150-400 ml) compared with 675 ml (range 500-800 ml) in the placebo group (P < 0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7 g/dl vs 5.3 g/dl, P < 0.001) and haematocrit (median 5% vs 13%, P < 0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P = 0.03). There were no significant differences between the groups in intra-operative pulse and blood pressure or post-operative white blood cell counts or temperature.. The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy.

Topics: Adult; Blood Loss, Surgical; Female; Hemoglobins; Hemostasis, Surgical; Humans; Injections; Leiomyoma; Pilot Projects; Uterine Neoplasms; Vasopressins

Laparoscopic myomectomy may be associated with considerable blood loss, especially in patients in whom no specific hemostatic measures are used. We conducted this retrospective comparative study to investigate whether misoprosol is an effective and safe alternative to vasopressin when used as single hemostatic agent in laparoscopic myomectomy.. Two hundred cases undergoing laparoscopic myomectomy (-ies), were included. Of these, 50 pre-treated with vaginal misoprostol 400mcg 1 h before surgery (group 1), were compared with two historic consecutive groups: 100 patients treated with intraoperative intra-myometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2), and 50 treated without use of any hemostatic agent (group3).. Mean procedure length did not differ significantly between the three groups (127.9 vs 100.6 vs 130.8 min). Mean estimated blood loss (EBL) was 179.7 ± 200.0 mL in group 1, compared with 147.8 ± 171.8 mL in group 2 (P = 0.793) and 321.8 ± 246.0 mL in group 3, respectively (P < 0.001). EBL was lower in group 2 in most of the study's subgroups of patients stratified according to size and number of fibroids compared with group 1, with the exception of patients with ≥4 fibroids, and ≥7 cm in size. In these subgroups, misoprostol appeared more effective. Neither agent was associated with serious adverse events.. Vaginal misoprostol can be effective in reducing blood loss during laparoscopic myomectomy. Although rates of EBL are, in general, higher compared with those obtained with vasopressin, they are significantly reduced compared with those observed when no hemostatic agent is used. In extended procedures, vaginal misoprostol, due to its prolonged uterotonic action, may be associated with reduced blood loss compared with vasopressin.

Topics: Blood Loss, Surgical; Female; Hemostatics; Humans; Laparoscopy; Misoprostol; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Topics: Adult; Atropine; Blood Loss, Surgical; Drug Combinations; Epinephrine; Female; Heart Arrest; Hemostatics; Humans; Injections, Intralesional; Uterine Myomectomy; Vasopressins

Our objective was to document current practices of abortion providers on the use of medications to decrease bleeding during surgical abortion.. We emailed surveys to 336 abortion providers through a professional listserv to elicit information on their use of medications to prevent and treat bleeding during first- and second-trimester surgical abortion.. One hundred sixty-eight (50%) providers responded to our survey. The majority were obstetrician-gynecologists (83%) working in an academic practice (66%). Most completed a fellowship in family planning (87%) and currently perform abortions up to 22 or 24weeks of gestation (63%). Seventy-two percent routinely used prophylactic medications for bleeding. Providers who routinely used medications to prevent bleeding most commonly chose vasopressin (83%). Providers preferred methylergonovine as a treatment for excessive bleeding in the second trimester, followed by misoprostol.. We found that most providers routinely use medications to prevent bleeding and use several different regimens to treat bleeding during abortion.. We found that surgical abortion providers use a range of medications to prevent and treat hemorrhage at the time of surgical abortion. Scant evidence is available to guide abortion providers on the use of medications to decrease hemorrhage during surgical abortion. To provide evidence-based recommendations for the prevention and treatment of clinically significant bleeding, researchers should target the most commonly used interventions.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Blood Loss, Surgical; Family Planning Services; Female; Gestational Age; Gynecology; Hemostatics; Humans; Methylergonovine; Misoprostol; Obstetrics; Oxytocics; Practice Patterns, Physicians'; Pregnancy; Surveys and Questionnaires; United States; Uterine Hemorrhage; Vasopressins

Topics: Blood Loss, Surgical; Hepatectomy; Humans; Nitroglycerin; Splanchnic Circulation; Vasopressins

Topics: Blood Loss, Surgical; Female; Humans; Laparoscopy; Leiomyoma; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

To demonstrate key steps in performing safe laparoscopic multiple myomectomy.. Video focuses on stepwise description of all major steps of the surgical technique.. Twenty-seven-year-old woman. Informed consent was taken from the subject, and the institutional review board approved this research.. Laparoscopic multiple myomectomy with morcellation in bag.. About one-third of women with fibroids present with symptoms severe enough to warrant treatment. We demonstrate a case of a 27-year-old woman with complaints of secondary infertility and menorrhagia. On examination the uterus was enlarged up to 24 weeks size. Ultrasonography mapping located 7 myomas ranging in size from of 3 to 10 cm and classified as International Federation of Gynecology and Obstetrics classes 2, 3, 4, 5, 6, and 7. Generally, laparotomy or laparoscopy and mini-laparotomy is performed for such cases of multiple myomas. However, the total laparoscopic approach can confer benefits if performed following safe steps and within good time. The following were the key steps of surgery: (1) Higher port position using Lee Huang point for primary port, (2) intermittent vasopressin use for each myomectomy, (3) cold technique of myomectomy, (4) myoma lace creation, (5) multiple layer suturing using double-ended barbed sutures, (6) myoma garland creation, and (7) morcellation in a stomach-shaped bag.. The intermittent use of vasopressin is effective in reducing blood loss. Suturing using barbed sutures is less time consuming. Creating lace of myomas by passing a thread through each myoma, prevents losing them in the abdominal cavity and creating garland of myomas by tying two free ends of the lace helps in easier bagging. Morcellation in bag prevents dissemination of bits of myoma and visceral injury. These steps help in performing laparoscopic multiple myomectomy safely. However, this technique should be reserved for selected cases and should be performed by surgical teams with the required expertise and experience.

Topics: Abdominal Cavity; Adult; Blood Loss, Surgical; Drug Administration Schedule; Female; Humans; Intraoperative Care; Laparoscopy; Leiomyoma; Menorrhagia; Neoplasms, Multiple Primary; Suture Techniques; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

The use of vasopressin and other vasoconstrictive agents to reduce blood loss during laparoscopic myomectomy significantly reduces blood loss and operative time. However, serious cardiovascular complications following the use of intramyometrial injection of vasopressin solution have also been reported. Most of these side effects are believed to be due to inadvertent intravascular injection of vasopressin solution.. To describe a new design of an injection needle. Pisat's visual vasopressor injection needle (VVIN) can be used during laparoscopic myomectomy to minimise the incidence of an inadvertent intravascular injection of a vasoconstrictor solution.. A total of 53 patients who underwent laparoscopic myomectomy at various hospitals in Mumbai, India were studied over a period of two years. Out of these, 23 patients were operated upon using a standard 5 mm laparoscopic injection needle, and 30 patients were operated on by using a VVIN. Out of the 23 patients in whom a regular needle was used, four patients (17.39%) demonstrated a significant (over 20% of pre-injection value), but transient, elevation in pulse and blood pressure readings at one minute post injection. This gradually returned to baseline at 10 minutes after the injection. None of the 30 patients in whom VVIN was used after confirming a negative aspiration demonstrated any significant change in post-injection pulse or blood pressure recordings.. Using a VVIN during a laparoscopic myomectomy enables the surgeon to detect an inadvertent vascular puncture very early, even in a small calibre blood vessel, and with much more sensitivity than a regular needle. This increases patient safety during the intramyometrial injection of a vasoconstrictive agent during myomectomy and reduces the incidence of catastrophic complications.

Topics: Blood Loss, Surgical; Blood Pressure; Female; Humans; Injections; Laparoscopy; Needles; Operative Time; Patient Safety; Pulse; Uterine Myomectomy; Vasoconstrictor Agents; Vasopressins

To minimize blood loss during hepatic surgery, various methods are used to reduce pressure and flow within the hepato-splanchnic circulation. In this study, the effect of low- to moderate doses of vasopressin, a potent splanchnic vasoconstrictor, on changes in portal and hepatic venous pressures and splanchnic and hepato-splanchnic blood flows were assessed in elective liver resection surgery.. Twelve patients were studied. Cardiac output (CO), stroke volume (SV), mean arterial (MAP), central venous (CVP), portal venous (PVP) and hepatic venous pressures (HVP) were measured, intraoperatively, at baseline and during vasopressin infusion at two infusion rates (2.4 and 4.8 U/h). From arterial and venous blood gases, the portal (splanchnic) and hepato-splanchnic blood flow changes were calculated, using Fick's equation.. CO, SV, MAP and CVP increased slightly, but significantly, while systemic vascular resistance and heart rate remained unchanged at the highest infusion rate of vasopressin. PVP was not affected by vasopressin, while HVP increased slightly. Vasopressin infusion at 2.4 and 4.8 U/h reduced portal blood flow (-26% and -37%, respectively) and to a lesser extent hepato-splanchnic blood flow (-9% and -14%, respectively). The arterial-portal vein lactate gradient was not significantly affected by vasopressin. Postoperative serum creatinine was not affected by vasopressin.. Short-term low to moderate infusion rates of vasopressin induced a splanchnic vasoconstriction without metabolic signs of splanchnic hypoperfusion or subsequent renal impairment. Vasopressin caused a centralization of blood volume and increased cardiac output. Vasopressin does not lower portal or hepatic venous pressures in this clinical setting.

Topics: Aged; Anesthesia; Blood Gas Analysis; Blood Loss, Surgical; Blood Pressure; Female; Hemodynamics; Humans; Liver; Liver Circulation; Male; Middle Aged; Portal Pressure; Splanchnic Circulation; Vasoconstrictor Agents; Vasopressins

To report the results of local injection of diluted vasopressin followed by suction curettage as a conservative treatment for women with cervical ectopic pregnancy, who wish to preserve their future fertility.. This was a retrospective chart review in a university hospital and a municipal hospital. We injected diluted vasopressin (Pitressin R, total amount of 4-10 units) transvaginally into the cervix surrounding the gestational sac, but not directly into the gestational sac, and/or the lower segment of the uterine body under transvaginal ultrasonographic guidance. After cessation of fetal heartbeats, we aspirated the conceptus by performing suction curettage. We injected additional vasopressin into the gestational sac in cases with a viable fetus after the initial injection. Forced contraction of the cervical smooth muscle facilitated removal of the conceptus with minimal blood loss during curettage. We measured operative time, total blood loss, complications, and the need for additional treatment.. We included 11 women. Mean patient age, gestational age, and serum human chorionic gonadotrophin (hCG) at the intervention were 31.2±6.4years, 6.0±0.6 weeks, and 18,370±21,570 IU/L, respectively. Mean size of the gestational sac was 19.6±9.5mm. The uterus was successfully preserved without any complications in all patients. All procedures were completed within 15min except for the first case (range: 5-33min). In 4 cases, the conceptus containing a gestational sac was spontaneously extruded en bloc from the external os after the injection. Additional systematic methotrexate administration was required in one case because of remaining villi at the implantation site with persistence of serum hCG levels after the procedure.. Local injection of diluted vasopressin and subsequent suction curettage is a feasible conservative treatment for cervical ectopic pregnancy.

Topics: Adult; Blood Loss, Surgical; Cervix Uteri; Chorionic Gonadotropin; Combined Modality Therapy; Feasibility Studies; Female; Hospitals, Municipal; Hospitals, University; Humans; Injections, Intramuscular; Japan; Operative Time; Postoperative Complications; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Ultrasonography, Doppler, Color; Vacuum Curettage; Vasoconstrictor Agents; Vasopressins

The aim of this study was to evaluate the effect of local injection of vasopressin on blood loss and secondary impact on complications during cesarean section in patients with placenta previa.. We retrospectively reviewed the medical records of all patients diagnosed with placenta previa admitted to our hospital. Two consecutive periods were compared. During period B, 59 patients underwent the local injection of a vasopressin solution (4 U in 20 mL of saline) into the placental implantation site after placental delivery. During period A, 50 patients underwent cesarean section without vasopressin injection, and were analyzed as a control group. The estimated blood loss was recorded, as were the complications during surgery. In addition, the expression of the vasopressin V1α receptor in uterine smooth muscle was evaluated by immunohistochemistry.. The mean estimated blood loss was significantly lower in the vasopressin group than in the control group. There were no statistically significant differences with surgical complications. The vasopressin V1α receptor was highly expressed in smooth muscle cells in the lower segment of the uterine body, whereas the immunoreactivity for the oxytocin receptor was faint in the lower segment.. The local injection of vasopressin into the placental implantation site significantly reduced the blood loss without increasing the morbidity.

Topics: Adult; Blood Loss, Surgical; Cesarean Section; Female; Humans; Injections; Placenta Previa; Pregnancy; Retrospective Studies; Vasopressins

To compare blood loss and need for blood transfusions in women who underwent abdominal myomectomies after receiving vasopressin or combined vasopressin and tourniquet.. A retrospective chart review was performed reviewing abdominal myomectomies that took place at our institution. Subjects were divided into three groups: no intervention, vasopressin, or combined vasopressin and tourniquet. Blood loss, need for blood transfusion, and drop in hemoglobin and hematocrit were compared across all groups.. One-hundred and thirty-two subjects were included in the study. No statistically significant difference was found between groups in blood loss, drop in hemoglobin or hematocrit, or blood transfusions.. Combined vasopressin and tourniquets was not associated with a statistically significant decrease in blood loss or need for blood transfusion.

Topics: Adult; Blood Loss, Surgical; Blood Transfusion; Blood Volume; Female; Hematocrit; Hemostasis, Surgical; Humans; Leiomyoma; Middle Aged; Retrospective Studies; Tourniquets; Uterine Neoplasms; Vasopressins; Young Adult

To describe resectoscopic treatment with vasopressin injection as an effective surgical intervention for ectopic pregnancy in previous cesarean delivery scar (PCDS) defect.. Case report.. University hospital.. Two women with ectopic pregnancy in PCDS defect.. The patients underwent transvaginal ultrasound examination, followed by operative hysteroscopy with vasopressin injection for evacuating the ectopic pregnancy in PCDS defect.. Conservation of the uterus.. Successful resectoscopic treatment of ectopic pregnancy in PCDS defect.. Resectoscopic treatment of ectopic pregnancy in PCDS defect is a safe and efficient technique that has the advantage of a rapid return to normal levels of β-hCG. Intracervical vasopressin administration could decrease intraoperative bleeding and provide a clear view during the operation.

Topics: Adult; Biomarkers; Blood Loss, Surgical; Cesarean Section; Chorionic Gonadotropin; Cicatrix; Female; Gestational Age; Hemostatics; Humans; Hysteroscopy; Injections; Pregnancy; Pregnancy, Ectopic; Treatment Outcome; Ultrasonography, Prenatal; Vasopressins

To test the compensatory role of endothelin-1 when acute blood loss is superimposed on anaesthesia, by characterizing the effect of systemic endothelin receptor subtype A (ET(A)) blockade on the haemodynamic and hormonal responses to haemorrhage in dogs anaesthetized with xenon/remifentanil (X/R) or isoflurane/remifentanil (I/R).. Prospective experimental randomized controlled study.. Six female Beagle dogs, 13.4 +/- 1.3 kg.. Animals were anaesthetized with remifentanil 0.5 microg kg(-1) minute(-1) plus either 0.8% isoflurane (I/R) or 63% xenon (X/R), with and without (Control) the systemic intravenous endothelin receptor subtype A antagonist atrasentan (four groups, n = 6 each). After 60 minutes of baseline anaesthesia, the dogs were bled (20 mL kg(-1)) over 5 minutes and hypovolemia was maintained for 1 hour. Continuous haemodynamic monitoring was performed via femoral and pulmonary artery catheters; vasoactive hormones were measured before and after haemorrhage.. In Controls, systemic vascular resistance (SVR), vasopressin and catecholamine plasma concentrations were higher with X/R than with I/R anaesthesia at pre-haemorrhage baseline. The peak increase after haemorrhage was higher during X/R than during I/R anaesthesia (SVR 7420 +/- 867 versus 5423 +/- 547 dyne seconds cm(-5); vasopressin 104 +/- 23 versus 44 +/- 6 pg mL(-1); epinephrine 2956 +/- 310 versus 177 +/- 99 pg mL(-1); norepinephrine 862 +/- 117 versus 195 +/- 33 pg mL(-1), p < 0.05). Haemorrhage reduced central venous pressure from 3 +/- 1 to 1 +/- 1 cm H(2)O (I/R, ns) and from 8 +/- 1 to 5 +/- 1 cm H(2)O (X/R, p < 0.05), but did not reduce mean arterial pressure, nor cardiac output. Atrasentan did not alter the haemodynamic and hormonal response to haemorrhage during either anaesthetic protocol.. Selective ET(A) receptor blockade with atrasentan did not impair the haemodynamic and hormonal compensation of acute haemorrhage during X/R or I/R anaesthesia in dogs.

Topics: Anesthesia; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Animals; Atrasentan; Blood Loss, Surgical; Catecholamines; Dog Diseases; Dogs; Endothelin A Receptor Antagonists; Endothelin-1; Epinephrine; Female; Hemodynamics; Hemorrhage; Isoflurane; Norepinephrine; Piperidines; Pyrrolidines; Remifentanil; Time Factors; Vascular Resistance; Vasopressins; Xenon

Topics: Blood Loss, Surgical; Dose-Response Relationship, Drug; Drug Dosage Calculations; Female; Gynecologic Surgical Procedures; Hemostatics; Humans; Injections, Intramuscular; Practice Guidelines as Topic; Vasopressins

Vasopressin is often used locally to reduce blood loss during surgery. The use of a local infiltration of a low concentration of vasopressin, less than 0.05-0.3 units/mL, has been considered to be safe. The use of low-dose vasopressin is not free of side effects, and it can also sometimes cause lethal complications.. In a healthy woman with multiple uterine myomas, we experienced a case of sudden cardiac arrest immediately after the intramyometrial injection of vasopressin at a total dose of 11 units (0.2 units/mL). The patient was successfully resuscitated.. Local intramyometrial infiltration of low-dose vasopressin may cause lethal cardiopulmonary complications.

Topics: Blood Loss, Surgical; Bradycardia; Dose-Response Relationship, Drug; Female; Heart Arrest; Hemostatics; Humans; Injections, Intramuscular; Laparoscopy; Leiomyomatosis; Vasopressins

Topics: Blood Loss, Surgical; Female; Hemostatics; Humans; Myometrium; Uterine Hemorrhage; Vasopressins

We describe the treatment of two patients with hemorrhagic shock unresponsive to volume replacement and catecholamines. Both patients responded to a small-dose infusion of vasopressin, which allowed tapering off of the catecholamines. The possible role of small-dose infusions of vasopressin in fluid- and catecholamine-resistant hemorrhagic shock is discussed.

Topics: Blood Loss, Surgical; Blood Volume; Catecholamines; Digestive System Surgical Procedures; Gastrointestinal Neoplasms; Humans; Hypovolemia; Male; Middle Aged; Pancreaticoduodenectomy; Shock, Hemorrhagic; Stomach Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Blood Loss, Surgical; Female; Hemostatics; Humans; Hysterectomy, Vaginal; Middle Aged; Retrospective Studies; Sodium Chloride; Vasopressins

To elucidate the mechanism by which myometrial vasopressin injection promotes hemostasis during myomectomy, we examined the expression of vasopressin V1a receptor transcripts in the myometrium. Vasopressin V1a receptor expression was ubiquitous, and the transcripts were detected in the myometrium not only of cycling and pregnant patients, but also of postmenopausal or GnRH agonist-treated patients. Based on these observations, we applied intraoperative myometrial vasopressin injection during myomectomy in a non-randomized study in a total of 84 patients. Vasopressin injection significantly reduced the intraoperative blood loss and postoperative hemoglobin fall in patients without and with GnRH agonist pretreatment. No serious complications occurred on account of the vasopressin injection. We conclude that intraoperative vasopressin injection is effective as a hormonal tourniquet even in GnRH agonist-pretreated myomectomy.

Topics: Adult; Blood Loss, Surgical; DNA Primers; Female; Gonadotropin-Releasing Hormone; Hemostasis, Surgical; Humans; Injections, Intralesional; Leiomyoma; Middle Aged; Receptors, Vasopressin; Reverse Transcriptase Polymerase Chain Reaction; Tourniquets; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Aged; Aged, 80 and over; Blood Loss, Surgical; Ethanol; Glycine; Humans; Male; Middle Aged; Prostatic Diseases; Therapeutic Irrigation; Transurethral Resection of Prostate; Vasopressins

Our aim was to report a new approach of endoscopic management (endoloop and encircling suture methods) for interstitial or cornual pregnancy and to determine the safety and effectiveness of these procedures and their effects on subsequent pregnancies.. This is an uncontrolled retrospective review of 24 patients treated for interstitial pregnancies through endoscopic operations with 14 to 72 months of follow-up at a large urban medical center. Blood loss, operation time, changes of serum human chorionic gonadotropin levels, the resumption of menstruation, and subsequent pregnancy after operation were analyzed.. Among 24 interstitial pregnancies, 3 had ruptured at the time of operation and 21 had not ruptured. Treatment consisted of either the vasopressin and electric cauterization method, the endoloop before evacuation of the conceptus method, or the encircling suture before evacuation of the conceptus method. The blood loss and operation time (mean +/- SD) for unruptured cases were 133 +/- 134 mL and 51.6 +/- 7.6 minutes in the vasopressin and electric cauterization group (n = 3), 32 +/- 22 mL and 28.5 +/- 6.4 minutes in the endoloop group (n = 15), and 40 +/- 17 mL and 35.0 +/- 5.0 minutes in the encircling suture group (n = 3). In 3 patients with ruptured pregnancy treated with the endoloop method, the blood loss and operation time (mean +/- SD) were 1100 +/- 854 mL and 82.5 +/- 51.6 minutes. Any of these operative methods resulted in rapid decline of serum human chorionic gonadotropin levels within 1 week with the exception of 1 case, in which the endoloop method was used; this patient needed additional treatment with methotrexate. Seventeen patients desired pregnancy in the future, and 15 eventually became pregnant. One of these 15 pregnancies ended in an ectopic pregnancy on the opposite side 6 months after the interstitial pregnancy. Three ended in a spontaneous abortion, and 11 were delivered by elective cesarean section at term before labor started. Operative records of cesarean section in 8 patients delivered at our institution showed little or no adhesions or defect in the cornual area of the previous operation.. The endoloop method and the encircling suture method are simple, safe, effective, and nearly bloodless. There were no uterine ruptures in the pregnancies subsequent to these methods of endoscopic management.

Topics: Adult; Blood Loss, Surgical; Cesarean Section; Chorionic Gonadotropin; Electrocoagulation; Endoscopy; Female; Humans; Menstruation; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Retrospective Studies; Rupture, Spontaneous; Time Factors; Treatment Outcome; Vasopressins

A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.

Topics: Blood Loss, Surgical; Cesarean Section; Female; Hemostatics; Humans; Myocardial Ischemia; Placenta Accreta; Pregnancy; Uterine Hemorrhage; Vasopressins

Topics: Blood Loss, Surgical; Coronary Artery Bypass; Humans; Myocardial Infarction; Thrombosis; Vasopressins