pituitrin and Shock--Surgical

Arginine vasopressin (AVP) is a naturally occurring peptide with diverse effects mediated through selective V1 and V2 receptors. About 10% of patients undergoing cardiopulmonary bypass develop postoperative vasodilatory shock requiring high-dose catecholamines. We sought to examine the role of AVP therapy in cardiac surgery.. A search of Medline was conducted through September 2018 using key words and medical subject headings (MeSH) relating to AVP, copeptin, and cardiac surgery. A systematic review was performed on articles as they pertained to AVP for use as a vasopressor after cardiovascular surgery complicated by vasodilatory shock.. A relative or absolute deficiency of Arginine vasopressin is associated with vasodilatory shock after cardiopulmonary bypass. Physiologic replacement with exogenous Arginine vasopressin results in significant increases in systemic vascular resistance and mean arterial pressure with decreased requirements of catecholamines. At doses of <0.1 U/min Arginine vasopressin is safe with very few adverse effects.. Post-cardiopulmonary bypass vasodilatory shock is largely due to a relative deficiency of Arginine vasopressin. Exogenous administration of low-dose Arginine vasopressin alone or in combination with traditional catecholamines is a safe and effective way to manage this type of vasodilatory shock.

Topics: Cardiac Surgical Procedures; Humans; Shock, Surgical; Vasoconstrictor Agents; Vasodilation; Vasopressins

Although nearly 10% of patients experience profound vasodilatory shock after cardiopulmonary bypass, some patients remain refractory to traditional resuscitation. Among this subset are patients who have inappropriately low levels of endogenous vasopressin. Thus, vasopressin replacement is an intuitively attractive intervention. The purposes of this review are to outline the pathophysiology of vasodilatory shock after cardiopulmonary bypass, to discuss the physiological role of endogenous vasopressin, to explore the clinical basis for vasopressin replacement, and to review the pharmacology and dosing guidelines.

Topics: Cardiopulmonary Bypass; Coronary Care Units; Education, Continuing; Humans; Practice Guidelines as Topic; Shock, Surgical; Systemic Inflammatory Response Syndrome; United States; Vasopressins

Topics: Acid-Base Equilibrium; Acidosis; Animals; Blood Pressure; Central Venous Pressure; Denervation; Dexamethasone; Humans; Infusions, Parenteral; Kanamycin; Oxygen Inhalation Therapy; Rabbits; Shock, Surgical; Spleen; Urine; Vasopressins

Topics: Adult; Anesthesia, Spinal; Humans; Male; Middle Aged; Postoperative Complications; Pylorus; Shock, Surgical; Sodium; Stimulation, Chemical; Urine; Vagotomy; Vasopressins; Water

A patient presented with multiple unrelated tumors and was found to have a small but functional adrenal pheochromocytoma. After pheochromocytoma resection, shock developed unresponsive to vasopressin in recommended doses (0.04 U/min infusion plus repeated 1-U boluses) but responded dramatically to an angiotensin II infusion (20 ng/kg/min) with a mean arterial pressure >100 mm Hg. The patient's blood pressure was maintained for 42 hours postoperatively with an infusion rate that ranged from 2 to 38 ng/kg/min. Because vasopressin may not always be effective for postresection shock in people with pheochromocytomas, angiotensin II may prove to be an effective alternative.

Topics: Adrenal Gland Neoplasms; Angiotensin II; Blood Pressure; Female; Humans; Middle Aged; Pheochromocytoma; Shock, Surgical; Treatment Outcome; Vasopressins

A 63-year-old female with known empty sella syndrome underwent coronary artery bypass grafting surgery. She became hypotensive immediately postoperatively and this did not respond to fluid resuscitation and inotropic therapy. Surgical re-exploration was undertaken and did not reveal any surgical cause. Pulmonary artery catheterisation confirmed a profound vasodilatory component to her shock. We believe this was due to unmasking of posterior pituitary hypofunction, in particular vasopressin insufficiency, due to metabolic stress. This rapidly corrected with an exogenous vasopressin infusion.

Topics: Coronary Artery Bypass; Empty Sella Syndrome; Female; Humans; Hypotension; Middle Aged; Shock, Surgical; Vasopressins

Vasodilatory shock is a syndrome with high mortality. It is becoming evident that depletion of antidiuretic hormone (ADH) after cardiac surgery or during sepsis plays an important role in the pathogenesis of this condition. Established vasodilatory shock responds well to exogenous ADH infusion. It is possible that preventing ADH depletion at an earlier stage may abrogate the onset of vasodilatory shock, or at least reduce its severity. This paper examines the evidence supporting this concept, and the potential areas of concern in considering this particular type of hormone replacement therapy.

Topics: Animals; Cardiopulmonary Bypass; Drug Administration Schedule; Heart-Lung Machine; Humans; Hypotension; Infusions, Intravenous; Models, Animal; Pulsatile Flow; Randomized Controlled Trials as Topic; Retrospective Studies; Safety; Shock, Septic; Shock, Surgical; Vasodilation; Vasopressins

Topics: Cardiopulmonary Bypass; Coronary Care Units; Shock, Surgical; Systemic Inflammatory Response Syndrome; Vasoconstrictor Agents; Vasopressins

Topics: Abdominal Muscles; Animals; Laparotomy; Male; Pentobarbital; Rats; Shock, Surgical; Stress, Physiological; Vasopressins; Water Deprivation

Topics: Electrocardiography; Heart; Pharmacology; Shock; Shock, Surgical; Surgical Procedures, Operative; Toxicology; Urology; Vasopressins