title: [Undesirable effects following the local injection of ornipressin during general anesthesia: can the risk be lessened? A prospective study].
abstract: Complications associated with local infiltration of ornithine-8-vasopressin (O-8-V) during general anesthesia (GA) are documented. Severe and extremely severe complications range around 20%; fatalities have been reported. The incidence of complications is associated with age, pre-existing cardiovascular or pulmorespiratory disease, and dosage administered. In a prospective study, we investigated 169 patients following a standardized protocol. Maximum dosage was 2 IU, diluted to 0.25 IU/ml in 0.9% saline. Patients with cardiovascular or respiratory disease and those below 1 or above 50 years of age were excluded. GA consisted of tracheal intubation and controlled ventilation with enflurane in N2O/O2 and intravenous fentanyl. Cardiovascular monitoring was by ECG with arrhythmia detection, plethysmography, and oscillometric - in some patients intraarterial - blood pressure measurement. Ventilatory monitoring included respiratory rate, tidal volume, inspiratory and expiratory O2 concentrations, capnometry, and end-tidal enflurane concentration. Local infiltration of the oral soft tissues with O-8-V was performed after a steady-state of anesthesia was achieved and 20 min before commencement of surgery. No severe or extremely severe complications or arrhythmias were observed. A moderate increase in blood pressure was seen in 43% of patients; in 10% this increase was 30-70 mmHg (systolic and/or diastolic). For data analysis, patients were allocated to 4 groups according to the dosage of O-8-V administered. Systolic and diastolic pressures increased to above control in all groups; however, no inter-group differences were found for blood pressure or heart rate. It is concluded that the risks associated with local infiltration of soft tissues with O-8-V during GA can be attenuated by a protocol such as the one established for this prospective study.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Klinik für Anaesthesiologie, Johannes Gutenberg-Universität Mainz.
authors.forename: P P
authors.initials: PP
authors.lastname: Kleemann
authors.forename: J P
authors.initials: JP
authors.lastname: Jantzen
authors.forename: W
authors.initials: W
authors.lastname: Dick
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009951:Ornipressin / Q000008:administration & dosage / Q000009:adverse effects*; D014667:Vasopressins / Q000009:adverse effects*
chemical_list: D014667:Vasopressins; D009951:Ornipressin
vernacular_title: Unerwünschte Wirkungen nach Lokalinjektion von Ornipressin während der Allgemeinanaesthesie: Lässt sich das Risiko vermindern? Eine prospektive Studie.