pituitrin and Leg-Ulcer

Primary pulmonary hypertension (PPH) is a progressive disease with frequent morbidity and mortality, including the risk of cardiac decompensation and death, during general anesthesia. Administration of IV epoprostenol (Flolan) improves symptoms and survival of patients with PPH and thus is an increasingly used long-term treatment for this condition. This therapy is associated with impaired platelet aggregation, which may complicate the perioperative management of patients with PPH. We present a case report of a patient with severe PPH receiving a continuous epoprostenol infusion undergoing skin grafting for a leg ulcer under spinal anesthesia. An IV infusion of vasopressin was given to prevent systemic hypotension resulting from sympathetic blockade while avoiding increases in pulmonary vascular resistance that may have resulted from catecholamine usage.

Topics: Anesthesia, Spinal; Epoprostenol; Female; Hemodynamics; Hemostatics; Humans; Hypertension, Pulmonary; Infusions, Intravenous; Leg Ulcer; Middle Aged; Platelet Aggregation Inhibitors; Skin Transplantation; Vasopressins

We describe the first case of Shy-Drager syndrome diagnosed on the basis of intraoperative hemodynamic changes. The initial hypertension in the supine position followed by severe hypotension after hydralazine administration, ultimately responsive to vasopressin, led to a diagnosis of Shy-Drager syndrome. We suggest that vasopressin may be the drug of choice in patients with Shy-Drager syndrome with refractory hypotension.

Topics: Adrenergic beta-Antagonists; Aged; Hemodynamics; Humans; Hypotension; Intraoperative Complications; Labetalol; Leg Ulcer; Male; Monitoring, Intraoperative; Multiple System Atrophy; Phenylephrine; Shy-Drager Syndrome; Vasoconstrictor Agents; Vasopressins

We report a 33-year-old man who developed cutaneous necrosis of the lower extremities with extensive bulla formation after i.v. administration of vasopressin for the treatment of bleeding esophageal varices. Due to its potent nonselective vasoconstrictive action, vasopressin not only may induce cardiac and gastrointestinal ischemia, but cutaneous ischemia as well. As in our patient, this may lead to extensive necrotic skin lesions at sites distant from the infusion.

Topics: Adult; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Leg Ulcer; Male; Skin Diseases, Vesiculobullous; Vasopressins