Hemodynamic Effects of Prophylactic Administration of Vasopressin in Patients Undergoing Off Pump Coronary Artery Bypass Graft Surgery: A Randomized Control Double Blind Interventional Study
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Abstract
Background: Off-pump coronary artery bypass grafting (OPCABG) is associated with hemodynamic fluctuations which usually require the use of various vasoactive drugs like norepinephrine and phenylephrine The aim of this study was to evaluate the effect of low dose vasopressin on hemodynamics in patients undergoing Off-pump Coronary Artery Bypass Graft Surgery (OPCABG).
Methods: Sixty patients undergoing elective Off pump coronary artery bypass grafting (CABG) having triple vessel coronary artery disease (CAD). were randomly divided into two groups: group A (n=30), patients received Vasopressin 0.03 IU/min via infusion pump (diluted in 50 ml syringe) during the LIMA extraction and continued till the end of surgery; group B (n==30), patients received normal saline infusion pump during the LIMA extraction and continued till the end of surgery. The anesthetic technique was the same in both the groups. Hemodynamic parameters were recorded at various time intervals during the surgery.
Results: HR, CO and CI were lower and MAP, SVR and SVRI were higher in vasopressin group. CVP was stable with no significant difference in SV and SVV.
Conclusion: To achieve better intra operative hemodynamic stability during the triple vascular coronary anastomosis and to cope up with post-operative vasodilatory shock, low dose vasopressin infusion is a safe option.
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[3] Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use a novel pressor agent. J Thorac Cardiovasc Surg. 1998; 116(6):973-80.
[4] Levin RL, Degrange MA, Bruno GF, Del Mazo CD, Taborda DJ, Griotti JJ, et al. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Ann Thorac Surg. 2004; 77(2):496-9.
[5] Papodopoulos G, Sinton E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E. Perioperative infusion of low dose vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study. J Cardiothorac Surg. 2010; 5:17-28.
[6] Gomes WJ, Carvalho AC, Palma JH, Teles CA, Branco JN, Silas MG, et al. Vasoplegic syndrome after open heart surgery. J Cardiovasc Surg (Torino). 1998; 39(5):619-23.
[7] Mekonto-Dessap A, Hauel R, Soustelle C, Kirsch M, Thebert D, Loisance DY. Risk factors for post cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function. Ann Thorac Surg. 2001; 71(5):1428-32.
[8] Ohri SK, Becket J, Brannan J, Keogh BE, Taylor KM. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilization and intra-mucosal pH. Ann Thorac surg;1994; 57(5):1193-9.
[9] Luckner G, Dünser MW, Jochberger S, Mayr VD, Wenzel V, Ulmer H, et al. Arginine vasopressin in 316 patients with advanced vasodilatory shock. Crit care Med. 2005; 33(11):2659-66.
[10] Dunser MW, Wenzel V, Mayr AJ, Hasibeder WR. Management of vasodilatory shock: defining the role of arginine vasopressin. Drugs. 2003; 63(3):237-56.
[11] Dunser MW, Mayr AJ, Ulmer H, Knotzer H, Sumann G, Pajk W, et al. Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study. Circulation. 2003; 107(18):2313-9
[12] Mc Graw C, Scarlett M, Irvine R, Ramphal P. Vasopressin for refractory hypotension during cardiopulmonary bypass. West Indian Med J. 2007; 56:550-4.
[13] Masetti P, Murphy SF, Kouchoukos NT. Vasopressin therapy for vasoplegic syndrome following cardiopulmonary bypass. J Card surg 2002;17: 485-9.
[14] Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, et al. Management of vasodilatory shock after cardiac surgery: Identification of predisposing factors and use of a novel pressor agent. J Thorac cardiovasc surg. 1998; 116:973-80.
[15] Fischer GW, Levin MA. Vasoplegia during cardiac surgery: current concepts and management. Semin Thorac Cardiovasc Surg. 2010; 22(2):140-4.
[16] Park KS, Yoo KY. Role of vasopressin in current anesthetic practice. Korean J Anesthesiol. 2017; 70(3):245.
[17] Jahangirifard A, Golestani Eraghi M, Fani K, Tafrishinejad A, Dadashpour N, Ahmadi ZH, et al. Effect of prophylactic vasopressin on hemodynamic parameters after coronary artery bypass graft surgery. J Cell Mol Anesth. 2017;2(3):97-102.
[18] Yimin H, Xiaoyo L, Yuping H, Weiyan L, Ning L. The effect of vasopressin on the hemodynamics in CABG patients. J Cardiothorac Surg. 2013; 8:49.
[19] Elgebaly AS, Sabry M. Infusion of low-dose vasopressin improves left ventricular function during separation from cardiopulmonary bypass: A double-blind randomized study. Ann Card Anaesth 2012; 15:128–33.
[20] Jeon Y, Ryu JH, Lim YJ, Kim CS, Bahk JH, Yoon SZ, et al. Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. Eur J Cardiothorac Surg. 2006; 29(6):952-6.
[21] Eissa MI. Prophylactic vasopressin versus norepinephrine in patients receiving the angiotensin-converting enzyme inhibitor undergoing coronary artery bypass graft surgery. Aamj. 2014; 12(4).
[22] Tayama E, Ueda T, Shojima T, Akasu K, Oda T, Fukunaga S, et al. Arginine vasopressin is an ideal drug after cardiac surgery for the management of low systemic vascular resistant hypotension concomitant with pulmonary hypertension. Interact Cardiovasc Thorac Surg. 2007; 6(6):715-9.
[23] Barrett LK, Singer M, Clapp LH. Vasopressin: mechanisms of action on the vasculature in health and in septic shock. Crit Care Med. 2007; 35(1):33-40.
[24] Landry DW, Levin HR, Gallant EM, Seo S, D'Alessandro D, Oz MC, et al. Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med. 1997; 25(8):1279-82.
[25] Mitra JK, Roy J, Sengupta S. Vasopressin: Its current role in anesthetic practice. Indian J Crit Care Med. 2011; 15(2):71-7.
[2] Gomes WJ, Erlichman MR, Batista-Filho ML, Knobel M, Almeida DR, Carvalho AC, et al. Vasoplegic syndrome after off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg. 2003; 23(2):165-9.
[3] Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use a novel pressor agent. J Thorac Cardiovasc Surg. 1998; 116(6):973-80.
[4] Levin RL, Degrange MA, Bruno GF, Del Mazo CD, Taborda DJ, Griotti JJ, et al. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Ann Thorac Surg. 2004; 77(2):496-9.
[5] Papodopoulos G, Sinton E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E. Perioperative infusion of low dose vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study. J Cardiothorac Surg. 2010; 5:17-28.
[6] Gomes WJ, Carvalho AC, Palma JH, Teles CA, Branco JN, Silas MG, et al. Vasoplegic syndrome after open heart surgery. J Cardiovasc Surg (Torino). 1998; 39(5):619-23.
[7] Mekonto-Dessap A, Hauel R, Soustelle C, Kirsch M, Thebert D, Loisance DY. Risk factors for post cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function. Ann Thorac Surg. 2001; 71(5):1428-32.
[8] Ohri SK, Becket J, Brannan J, Keogh BE, Taylor KM. Effects of cardiopulmonary bypass on gut blood flow, oxygen utilization and intra-mucosal pH. Ann Thorac surg;1994; 57(5):1193-9.
[9] Luckner G, Dünser MW, Jochberger S, Mayr VD, Wenzel V, Ulmer H, et al. Arginine vasopressin in 316 patients with advanced vasodilatory shock. Crit care Med. 2005; 33(11):2659-66.
[10] Dunser MW, Wenzel V, Mayr AJ, Hasibeder WR. Management of vasodilatory shock: defining the role of arginine vasopressin. Drugs. 2003; 63(3):237-56.
[11] Dunser MW, Mayr AJ, Ulmer H, Knotzer H, Sumann G, Pajk W, et al. Arginine vasopressin in advanced vasodilatory shock: a prospective, randomized, controlled study. Circulation. 2003; 107(18):2313-9
[12] Mc Graw C, Scarlett M, Irvine R, Ramphal P. Vasopressin for refractory hypotension during cardiopulmonary bypass. West Indian Med J. 2007; 56:550-4.
[13] Masetti P, Murphy SF, Kouchoukos NT. Vasopressin therapy for vasoplegic syndrome following cardiopulmonary bypass. J Card surg 2002;17: 485-9.
[14] Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, et al. Management of vasodilatory shock after cardiac surgery: Identification of predisposing factors and use of a novel pressor agent. J Thorac cardiovasc surg. 1998; 116:973-80.
[15] Fischer GW, Levin MA. Vasoplegia during cardiac surgery: current concepts and management. Semin Thorac Cardiovasc Surg. 2010; 22(2):140-4.
[16] Park KS, Yoo KY. Role of vasopressin in current anesthetic practice. Korean J Anesthesiol. 2017; 70(3):245.
[17] Jahangirifard A, Golestani Eraghi M, Fani K, Tafrishinejad A, Dadashpour N, Ahmadi ZH, et al. Effect of prophylactic vasopressin on hemodynamic parameters after coronary artery bypass graft surgery. J Cell Mol Anesth. 2017;2(3):97-102.
[18] Yimin H, Xiaoyo L, Yuping H, Weiyan L, Ning L. The effect of vasopressin on the hemodynamics in CABG patients. J Cardiothorac Surg. 2013; 8:49.
[19] Elgebaly AS, Sabry M. Infusion of low-dose vasopressin improves left ventricular function during separation from cardiopulmonary bypass: A double-blind randomized study. Ann Card Anaesth 2012; 15:128–33.
[20] Jeon Y, Ryu JH, Lim YJ, Kim CS, Bahk JH, Yoon SZ, et al. Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. Eur J Cardiothorac Surg. 2006; 29(6):952-6.
[21] Eissa MI. Prophylactic vasopressin versus norepinephrine in patients receiving the angiotensin-converting enzyme inhibitor undergoing coronary artery bypass graft surgery. Aamj. 2014; 12(4).
[22] Tayama E, Ueda T, Shojima T, Akasu K, Oda T, Fukunaga S, et al. Arginine vasopressin is an ideal drug after cardiac surgery for the management of low systemic vascular resistant hypotension concomitant with pulmonary hypertension. Interact Cardiovasc Thorac Surg. 2007; 6(6):715-9.
[23] Barrett LK, Singer M, Clapp LH. Vasopressin: mechanisms of action on the vasculature in health and in septic shock. Crit Care Med. 2007; 35(1):33-40.
[24] Landry DW, Levin HR, Gallant EM, Seo S, D'Alessandro D, Oz MC, et al. Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med. 1997; 25(8):1279-82.
[25] Mitra JK, Roy J, Sengupta S. Vasopressin: Its current role in anesthetic practice. Indian J Crit Care Med. 2011; 15(2):71-7.
| Files | ||
| Issue | Vol 8 No Supp. 1 (2022): Supplement 1 |
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| Section | Research Article(s) | |
| Keywords | ||
| Off pump coronary artery bypass grafting (OPCABG) Vasodilatory shock Low dose vasopressin | ||
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How to Cite
1.
Verma I, Beelwal P, Verma C, Vyas C. Hemodynamic Effects of Prophylactic Administration of Vasopressin in Patients Undergoing Off Pump Coronary Artery Bypass Graft Surgery: A Randomized Control Double Blind Interventional Study. Arch Anesth & Crit Care. 2022;8(Supp. 1):377-382.
