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VOLUME 5 , ISSUE 2 ( April-June, 2019 ) > List of Articles

CASE REPORT

Ventricular Tachycardia Caused by Intramyometrial Infiltration of Vasopressin during Laparoscopic Myomectomy: An Anesthesiologist's Nightmare

Keywords : Intramyometrial injection, Laparoscopic myomectomy, Vasopressin, Ventricular tachycardia

DOI: 10.5005/jp-journals-10045-00118

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

All endoscopic procedures demand minimal blood loss during surgery to achieve good visibility which facilitates the speed of surgery. Vasopressin is often used for local infiltration during uterine myomectomy. It has good clinical effects but its systemic absorption may pose significant challenges for the anesthesiologist. It may sometimes lead to lethal complications. The loss of peripheral pulse along with bradycardia, non-measurable blood pressure, and cardiac complications have been reported after intramyometrial injection of vasopressin. Here, we describe a patient with multiple uterine fibroids who developed ventricular tachycardia within 2–3 minutes after intramyometrial infiltration of vasopressin diluted in normal saline. The total dose of vasopressin being 5.36 units (0.067 units/mL) with severe peripheral arterial vasospasm, increased blood pressure, and ventricular tachycardia followed by pulmonary edema. The patient was successfully resuscitated.


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  1. Hung MH, Wang YM, et al. Intramyometrial injection of vasopressin causes bradycardia and cardiac arrest-report of 2 cases. Acta Anaesthesiol Taiwan 2006;44:243–247.
  2. Butala BP, Shah VR, et al. Bradycardia and severe vasospasm caused by intramyometrial injection of vasopressin during myomectomy. Saudi J of Anaesth 2014;8(3):396–398.
  3. Alexander GD. Morris Brown A safe dose of Vasopressin for paracervical infiltration. Anesth Analg 1995 Aug;81(2):428. DOI: 10.1213/00000539-199508000-00053.
  4. Kabade SD, Sachidananda R, et al. Intramyometrial vasopressin: A fear for anesthetist? Saudi J Anaesth 2017 Oct–Dec;11(4):494–495. DOI: 10.4103/sja.SJA_102_17.
  5. Deschamps A, Krishnamurthy S. Absence of pulse and blood pressure following vasopressin injection for myomectomy. Can J of Anaesthesia 2005;52:552–553. DOI: 10.1007/BF03016547.
  6. Frishman G. Vasopressin: if some is good, is more better? Obstet Gynecol 2009(Pt 2):476–477. DOI: 10.1097/AOG.0b013e31819698bb.
  7. Pisat SV. Pisat's visual vasopressin injection needle: a new device for increasing patient safety in laparoscopic myomectomy. J Obstet Gynaecol India 2017;67(6):451–453. DOI: 10.1007/s13224-017- 1048-6
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