title: Ornipressin (Por 8): An efficient alternative to counteract hypotension during combined general/epidural anesthesia.
abstract: We sought to evaluate the efficacy and side effect profile of a small dose of ornipressin, a vasopressin agonist specific for the V1 receptor, administered to reverse the hypotension associated with combined general/epidural anesthesia. A total of 60 patients undergoing intestinal surgery were studied. After the induction of anesthesia, 7-8 mL of bupivacaine 0.5% with 2 microg/kg clonidine and 0.05 microg/kg sufentanil after an infusion of 5 mL of bupivacaine 0.06% with 0.5 microg x kg(-1) x h(-1) clonidine and 0.1 microg/h of sufentanil were administered by an epidural catheter placed at T7-8 vertebral interspace. When 20% reduction of baseline arterial blood pressure developed, patients were randomly assigned to receive, in a double-blinded design, dopamine started at 2 microg x kg(-1) x min(-1), norepinephrine started at 0.04 microg x kg(-1) x min(-1), or ornipressin started at 1 IU/h. Fifteen patients presenting without hypotension were used as control subjects. Beside routine monitoring, S-T segment analysis, arterial lactacidemia, and gastric tonometry were performed. Ornipressin restored arterial blood pressure after 8 +/- 2 vs 7 +/- 3 min in the norepinephrine group and 11 +/- 3 min in the dopamine group (P < 0.05). This effect was achieved with 2 IU/h of ornipressin in most of the patients (11 of 15). Ornipressin did not induce any modification of the S-T segment; however, it significantly increased intracellular gastric PCO(2) (P < 0.05), indicating splanchnic vasoconstriction.
  
  
  CONCLUSIONS
  In the population studied, small-dose ornipressin was effective to restore arterial blood pressure without causing major ischemic side effects.
authors.affiliation: Department of Anesthesiology, University of Louvain, St. Luc Hospital, Brussels, Belgium. dekock@anes.ucl.ac.be
authors.forename: M
authors.initials: M
authors.lastname: De Kock
authors.forename: P F
authors.initials: PF
authors.lastname: Laterre
authors.forename: P
authors.initials: P
authors.lastname: Andruetto
authors.forename: L
authors.initials: L
authors.lastname: Vanderessen
authors.forename: S
authors.initials: S
authors.lastname: Dekrom
authors.forename: B
authors.initials: B
authors.lastname: Vanderick
authors.forename: P
authors.initials: P
authors.lastname: Lavand'homme
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D004298:Dopamine / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009129:Muscle Tonus / Q000187:drug effects; D009638:Norepinephrine / Q000627:therapeutic use; D009951:Ornipressin / Q000627:therapeutic use*; D013152:Splanchnic Circulation / Q000187:drug effects; D013270:Stomach / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D009951:Ornipressin; D004298:Dopamine; D009638:Norepinephrine