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VOLUME 15 , ISSUE 2 ( April, 2011 ) > List of Articles


Vasopressin: Its current role in anesthetic practice

Saikat Sengupta, Jayeeta Roy, Jayanta K. Mitra

Keywords : Cardiopulmonary resuscitation, hemorrhagic shock, operating room, septic shock, vasopressin

Citation Information : Sengupta S, Roy J, Mitra JK. Vasopressin: Its current role in anesthetic practice. Indian J Crit Care Med 2011; 15 (2):71-77.

DOI: 10.4103/0972-5229.83006

License: CC BY-ND 3.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2011; The Author(s).


Vasopressin or antidiuretic hormone is a potent endogenous hormone, which is responsible for regulating plasma osmolality and volume. In high concentrations, it also raises blood pressure by inducing moderate vasoconstriction. It acts as a neurotransmitter in the brain to control circadian rhythm, thermoregulation and adrenocorticotropic hormone release. The therapeutic use of vasopressin has become increasingly important in the critical care environment in the management of cranial diabetes insipidus, bleeding abnormalities, esophageal variceal hemorrhage, asystolic cardiac arrest and septic shock. After 10 years of ongoing research, vasopressin has grown to a potential component as a vasopressor agent of the anesthesiologist′s armamentarium in the treatment of cardiac arrest and severe shock states.

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  1. Mentzelopoulos SD, Zakynthinos SG, Tzoufi M, Katsios N, Papastylianou A, Gkisioti S, et al. Vasopressin, epinephrine, and corticosteroids for in-hospital cardiac arrest. Arch Intern Med 2009;169:15-24.
  2. Kam PC, Williams S, Yoong FF. Vasopressin and terlipressin: Pharmacology and its clinical relevance. Anaesthesia 2004;59:993-1001.
  3. Schrier RW, Berl T, Anderson RJ. Osmotic and nonosmotic control of vasopressin release. Am J Physiol 1979;236:F321-32.
  4. Kaufmann JE, Vischer UM. Cellular mechanisms of the hemostatic effects of desmopressin (DDAVP). J Thromb Haemost 2003;1:682-9.
  5. Dünser MW, Mayr AJ, Ulmer H, Knotzer H, Sumann G, Pajk W, et al. Arginine vasopressin in advanced vasodilatory shock: A prospective randomised study. Circulation 2003;107:2313-9.
  6. Russell JA, Walley KR, Singer J, Gordon AC, Hébert PC, Cooper DJ, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358:877-87.
  7. Robin JK, Oliver JA, Landry DW. Vasopressin deficiency in the syndrome of irreversible shock. J Trauma 2003;54:149-54.
  8. Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D. Circulating vasopressin levels in septic shock. Crit Care Med 2003;31:1752-8.
  9. Dünser MW, Hasibeder WR, Wenzel V, Schwarz S, Ulmer H, Knotzer H, et al. Endocrinologic response to vasopressin infusion in advanced vasodilatory shock. Crit Care Med 2004;32:1266-71.
  10. Landry DW, Levin HR, Gallant EM, Ashton RC, Jr, Seo S, D′Alessandro D, et al. Vasopressin deficiency contributes to the vasodilatation of septic shock. Circulation 1997;95:1122-5.
  11. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign Management Guidelines Comittee: Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73.
  12. Morales D, Madigan J, Cullinane S, Chen J, Heath M, Oz M, et al. Reversal of vasopressin of intractable hypotension in the late phase of haemorrhagic shock. Circulation 1999;100:226-9.
  13. Albright TN, Zimmerman MA, Selzman CH. Vasopressin in the cardiac surgery intensive care unit. Am J Crit Care 2002;11:326-32.
  14. Dünser MW, Mayr AJ, Stallinger A, Ulmer H, Ritsch N, Knotzer H, et al. Cardiac performance during vasopressin infusion in postcardiotomy shock. Intensive Care Med 2002;28:746-51.
  15. Kill C, Wranze E, Wulf H. Sucessful treatment of severe anaphylactic shock with vasopressin. Int Arch Allergy Immunol 2004;134:260-1.
  16. Tsuda A, Tanaka KA, Huraux C, Szlam F, Sato N, Yamaguchi K, et al. The in vitro reversal of histamine-induced vasodilatation in the human internal mammary artery. Anaesth Analg 2001;93:1453-9.
  17. De Kock M, Laterre PF, Andruetto P, Vanderessen L, Dekrom S, Vanderick B, et al. Ornipressin (Por 8): An efficient alternative to counteract hypotension during combined general/epidural anaesthesia. Anesth Analg 2000;90:1301-7.
  18. Yeh CC, Wu CT, Lu CH, Yang CP, Wong CS. Early use of small dose vasopressin for unstable haemodynamics in an acute brain injury patient refractory to catecholamine treatment: A case report. Anesth Analg 2003;97:577-9.
  19. Bradley PG, Allen EK, Menon DK. Terlipressin for cerebral perfusion pressure support in a patient with septic shock. Anaesthesia 2004;59:619-20.
  20. Jochberger S, Wenzel V, Dünser MW. Arginine vasopressin as a rescue vasopressor agent in the operating room. Curr Opin Anaesthesiol 2005;18:396-404.
  21. Chen JM, Cullinane S, Spanier TB, Artrip JH, John R, Edwards NM, et al. Vasopressin deficiency and pressor hypersensitivity in hemodynamically unstable organ donors. Circulation 1999;100:244-6.
  22. Chernow B, Roth BL. Pharmacologic manipulation of the peripheral vasculature in shock: Clinical and experimental approaches. Circ Shock 1986;18:141-55.
  23. Augoustides JG, Abrams M, Berkowitz D, Fraker D. Vasopressin for hemodynamic rescue in catecholamine-resistant vasoplegic shock after resection of massive pheochromocytoma. Anesthesiology 2004;101:1022-4.
  24. Veall GR, Peacock JE, Bax ND, Reilly CS. Review of the anaesthetic management of 21 patients undergoing laparotomy for carcinoid syndrome. Br J Anaesth1994;72:335-41.
  25. Patel BM, Chittock DR, Russell JA, Walley KR. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002;96:576-82.
  26. Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 2004;350:105-13.
  27. Mukoyama T, Kinoshita K, Nagao K, Tanjoh K. Reduced effectiveness of vasopressin in repeated doses for patients undergoing prolonged cardiopulmonary resuscitation. Resuscitation 2009;80:755-61.
  28. Ioannou G, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev 2003;1:CD002147.
  29. Ozgönenel B, Rajpurkar M, Lusher JM. How do you treat bleeding disorders with desmopressin? Postgrad Med J 2007;83:159-63.
  30. Toumba M, Stanhope R. Morbidity and mortality associated with vasopressin analogue treatment. J Pediatr Endocrinol Metab 2006;19:197-201.
  31. Kahn JM, Kress JP, Hall JB. Skin necrosis after extravasation of low-dose vasopressin administered for septic shock. Criti Care Med 2002;30:1899-901.
  32. Stiell IG, Hébert PC, Wells GA, Vandemheen KL, Tang AS, Higginson LA, et al. Vasopressin versus epinephrine for inhospital cardiac arrest: A randomised controlled trial. Lancet 2001;358:105-9.
  33. Morris DC, Dereczyk BE, Grzybowski M, Martin GB, Rivers EP, Wortsman J, et al. Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation. Acad Emerg Med 1997;4:878-83.
  34. Lindner KH, Prengel AW, Brinkmann A, Strohmenger HU, Lindner IM, Lurie KG. Vasopressin administration in refractory cardiac arrest. Ann Intern Med 1996;124:1061-4.
  35. Grmec S, Kamenik B & Mally S.Vasopressin in refractory out-of-hospital ventricular fibrillation: Preliminary results. Crit Care 2002;6:P162.
  36. Sharshar T, Annane D. Endocrine effects of vasopressin in critically ill patients. Best Pract Res Clin Anaesthesiol 2008;22:265-73.
  37. Lin IY, Ma HP, Lin AC, Chong CF, Lin CM, Wang TL. Low plasma vasopressin/norepinephrine ratio predicts septic shock. Am J Emerg Med 2005;23:718-24.
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