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BJA Advance Access originally published online on July 27, 2007
British Journal of Anaesthesia 2007 99(4):552-555; doi:10.1093/bja/aem180
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Use of vasopressin after Caesarean section in idiopathic pulmonary arterial hypertension

L. C. Price1,3,*, P. Forrest4, V. Sodhi5, D. L. Adamson2, C. Nelson-Piercy6, M. Lucey3 and L. S. Howard1

1 Department of Respiratory Medicine and Pulmonary Hypertension Service
2 Department of Cardiac Services, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
3 Department of Intensive Care Medicine
4 Department of Anaesthesia, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney 2050, New South Wales, Australia
5 Department of Anaesthesia
6 Department of Obstetric Medicine, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London, W12 0HS, UK

* Corresponding author: Pulmonary Hypertension Service, Department of Cardiac Services, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK. E-mail: lauracprice{at}hotmail.com

We report the successful use of vasopressin in the management of hypotension in association with severe right ventricular (RV) failure in two patients with advanced idiopathic pulmonary arterial hypertension. Both patients were pregnant and developed systemic hypotension after delivery by Caesarean section. Placental autotransfusion and possibly oxytocin use were thought to be the major contributing factors in worsening RV function. After the use of vasopressin in both patients, cardiovascular variables improved without untoward effect on RV function, and provided rescue therapy for systemic hypotension in this setting. Vasopressin, a direct vasopressor acting via V1 receptors on the vascular endothelium, has been shown to cause pulmonary vasodilatation experimentally and in animal models of pulmonary hypertension. Its synthetic analogue, terlipressin, has been shown to reduce pulmonary vascular resistance in humans with cirrhosis. Vasopressin may therefore have differential effects on the pulmonary and systemic circulations, allowing systemic pressure to be supported without detrimental effects on the pulmonary circulation.

Keywords: anaesthesia, obstetric; pregnancy; pulmonary hypertension; right heart failure; vasopressin


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