Vasoplegic syndrome after off-pump coronary artery bypass surgery: an unusual complication.
We report the case of a 65-year-old man who developed norepinephrine-resistant vasoplegic syndrome after elective off-pump coronary artery bypass surgery (OPCAB). The failure of norepinephrine to improve the patient's hemodynamics prompted us to start treatment with vasopressin; within 30 minutes, the hemodynamics began to improve. After 12 hours, the patient was stable enough to be weaned from the vasopressin. He was discharged from the hospital on the 10th postoperative day. To our knowledge, ours is the 1st report of vasopressin use for vasodilatory shock after OPCAB in the English-language medical literature. Herein, we discuss the pathophysiology and management of vasoplegic syndrome--which is controversial--with special emphasis on the use of vasopressin in this situation.
Raja
Shahzad G
SG
Department of Cardiac Surgery, Harefield Hospital, Middlesex, United Kingdom. drrajashahzad@hotmail.com
Dreyfus
Gilles D
GD
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D016534:Cardiac Output, High / Q000188:drug therapy / Q000209:etiology*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D013577:Syndrome; D013610:Tachycardia / Q000188:drug therapy / Q000209:etiology*; D014655:Vascular Resistance / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D014667:Vasopressins
Anesth Analg. 1995 Mar;80(3):473-9
7864410
Circ Shock. 1994 Jul;43(3):122-9
7850932
Circulation. 1997 Mar 4;95(5):1122-5
9054839
Eur J Pharmacol. 1997 Feb 12;320(2-3):167-74
9059850
J Hypertens. 1997 Jun;15(6):627-32
9218182
J Cardiothorac Vasc Anesth. 1998 Jun;12(3):326-9
9636919
Anesth Analg. 1998 Aug;87(2):266-71
9706914
J Cardiovasc Surg (Torino). 1998 Oct;39(5):619-23
9833722
J Thorac Cardiovasc Surg. 1998 Dec;116(6):973-80
9832689
J Trauma. 1999 Oct;47(4):699-703; discussion 703-5
10528604
Ann Thorac Surg. 2000 Jan;69(1):102-6
10654495
Crit Care Med. 2000 Jan;28(1):249-52
10667533
Thorac Cardiovasc Surg. 2000 Dec;48(6):364-9
11145406
Ann Thorac Surg. 2001 May;71(5):1428-32
11383777
Anesthesiology. 2002 Jul;97(1):215-52
12131125
Chest. 2002 Sep;122(3):1061-6
12226053
Eur J Cardiothorac Surg. 2003 Feb;23(2):165-9
12559337
J Card Surg. 2002 Nov-Dec;17(6):485-9
12643457
J Cardiovasc Pharmacol. 1980 Jul-Aug;2(4):367-76
6156335
Am J Med. 1983 Feb;74(2):265-71
6824005
Proc Natl Acad Sci U S A. 1984 Dec;81(23):7661-4
6150486
Circ Shock. 1986;18(2):141-55
3004777
Arch Intern Med. 1987 Jul;147(7):1273-8
3606284
Crit Care Med. 1988 Jul;16(7):663-6
3371042
J Clin Invest. 1989 Jan;83(1):331-5
2783426
J Thorac Cardiovasc Surg. 1994 Mar;107(3):942-3
8127127
Ann Thorac Surg. 1994 May;57(5):1193-9
8179384
J Thorac Cardiovasc Surg. 1994 Oct;108(4):626-35
7934095
Cathet Cardiovasc Diagn. 1996 Jun;38(2):123-30; discussion 131-2
8776512