title: Case report: Severe vasospasm mimics hypotension after high-dose intrauterine vasopressin.
abstract: Intramyometrial vasopressin injection reduces bleeding during myomectomy. Subsequent loss of peripheral pulses and nonmeasurable arterial blood pressure have been attributed to cardiovascular collapse or hypotension. When interpreted as global hypotension, treatment with vasopressors or according to Advanced Cardiac Life Support resuscitation protocols has been associated with cardiac complications. We describe a patient who developed loss of peripheral pulses and nonmeasurable blood pressure by noninvasive means after myometrial administration of 60 U vasopressin, with documented severe peripheral arterial vasospasm and elevated proximal blood pressure. We discuss the pathophysiology and emphasize the danger of misinterpreting pulselessness as global hypotension instead of vasospasm in this setting.
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin, and Medical College of Wisconsin Affiliated Hospitals, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA. mriess@mcw.edu
authors.forename: Matthias L
authors.initials: ML
authors.lastname: Riess
authors.forename: Jason G
authors.initials: JG
authors.lastname: Ulrichs
authors.forename: Paul S
authors.initials: PS
authors.lastname: Pagel
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Woehlck
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007267:Injections; D007889:Leiomyoma / Q000601:surgery; D009215:Myometrium; D058729:Peripheral Arterial Disease / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000187:drug effects; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000601:surgery; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014667:Vasopressins / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins