Vasopressin during spinal anesthesia in a patient with primary pulmonary hypertension treated with intravenous epoprostenol.
Primary pulmonary hypertension (PPH) is a progressive disease with frequent morbidity and mortality, including the risk of cardiac decompensation and death, during general anesthesia. Administration of IV epoprostenol (Flolan) improves symptoms and survival of patients with PPH and thus is an increasingly used long-term treatment for this condition. This therapy is associated with impaired platelet aggregation, which may complicate the perioperative management of patients with PPH. We present a case report of a patient with severe PPH receiving a continuous epoprostenol infusion undergoing skin grafting for a leg ulcer under spinal anesthesia. An IV infusion of vasopressin was given to prevent systemic hypotension resulting from sympathetic blockade while avoiding increases in pulmonary vascular resistance that may have resulted from catecholamine usage.
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
Edward B
EB
Braun
Christopher A
CA
Palin
Charles W
CW
Hogue
D000775:Anesthesia, Spinal; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007871:Leg Ulcer / Q000601:surgery; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016038:Skin Transplantation; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*
D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D014667:Vasopressins; D011464:Epoprostenol