The data on the use of vasopressin in pulmonary hypertension is mixed. It should not be your first choice but if the Norepinephrine fails to get the job done here I would use it next.
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Br J Anaesth. 2007 Oct;99(4):552-5. Epub 2007 Jul 27.
Use of vasopressin after Caesarean section in idiopathic pulmonary arterial hypertension.
Price LC, Forrest P, Sodhi V, Adamson DL, Nelson-Piercy C, Lucey M, Howard LS.
Source
Department of Respiratory Medicine and Pulmonary Hypertension Service, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
[email protected]
Abstract
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.
PMID: 17660458 [PubMed - indexed for MEDLINE] Free full text
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