Vasopressin and its role in anaesthesiology and intensive care medicine


Authors: M. Balík 1;  V. Černý 2;  V. Šrámek 3;  M. Matějovič 4;  J. Kunstýř 1
Authors‘ workplace: KARIM 1. LF UK a VFN, Praha 1;  KARIM Masarykova nemocnice, Ústí nad Labem 2;  KAR FN U sv. Anny, Brno 3;  1. interní klinika FN PLzeň 4
Published in: Anest. intenziv. Med., 26, 2015, č. 4, s. 223-227
Category: Special article

Overview

Vasopressin has an essential role in the regulation of the vasomotor tone. Its insufficient level plays a substantial role in the pathophysiology of refractory shock associated with sepsis, haemorrhage and extracorporeal circulation. Its role in the control of arterial pressure is emphasised at times when other systems are blocked, not functional, or incapable of maintaining blood pressure – for example in septic shock or in refractory vasoparalysis. A low dose of vasopressin may contribute to normalisation of the vascular tone and perfusion of vital organs.

The indications for vasopressin administration include septic shock with a need for high-dose noradrenaline infu-sion, particularly in patients with myocardial dysfunction and pulmonary hypertension. Vasopressin is indicated not only in vasoparalysis related to sepsis but also due to antihypertensive drug poisoning and in cardiac anaesthesia. Its role is recognized in brain-dead organ donors, portal hypertension and during cardiopulmonary resuscitation.

In contrast to many EU countries, Canada, Australia and New Zealand, the availability of vasopressin in the Czech Republic depends on special delivery which makes it a scarce drug for a critically ill patient who needs the drug urgently. The only available option is its synthetic analogue terlipressin which possesses different pharmacodynamics with a long halftime, and its infusion is rather difficult to operate with a significantly higher number of side effects. Therefore, the registration of vasopressin on the Czech market would be very desirable.

Keywords:
vasopressin – septic shock – hypotension – vasoparalysis – portal hypertension – organ donors – cardiopulmonary resuscitation


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Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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