Lets talk vasopressin

[anes]

Why? have you seen problems with larger doses?

I've seen 2 units of vasopressin shoot a blood pressure up from 70 sbp to over 200. typically a much stronger response than epinephrine.

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[anes]

One of my favorite tricks, next to the syringe of neo in the IV bag for c/s.
If I place an epidural for s surgical case I always use it. But like everyone knows, it's sometimes difficult to use the epidural along with a GA without having to support the BP. Well, you can't really send the pt to the floor with neo in the IV bag so whatcha gonna do? I inject about 30mg of ephedrine in the shoulder at the end of the case and nobody ever knows. BP stays in a reasonable range and I never get a call.

I average doing IM EPHEDRINE about once a week week, works well. 25 mg is usually sufficient.

 

[Noyac]

I've seen 2 units of vasopressin shoot a blood pressure up from 70 sbp to over 200. typically a much stronger response than epinephrine.

I have ever seen this and would suggest something else may have been at play. It is not anywhere near epi in my experience.

 

[Arch Guillotti]

I have ever seen this and would suggest something else may have been at play. It is not anywhere near epi in my experience.

I don't think the response to vasopressin is as profound as epi and that's why I like it better sometimes since it seems easier to titrate. I do think it can shoot up the blood pressure significantly though. I have seen a pretty profound response to a couple of units (which is why I start off dosing low).

 

[BLADEMDA]

I have ever seen this and would suggest something else may have been at play. It is not anywhere near epi in my experience.

If vasopressin is used when it really isn't needed (mild,typical hypotension following Propofol IV for example) then 2 units may indeed cause some serious hypertension. But, if vasopressin is utilized only for refractory hypotension, sepsis, anaphylaxis, etc then 2 units would be well tolerated with the likelihood that even more will be needed.