Objectives: Vasoconstrictors are often used in gynaecology for vaginal surgery. Ornipressin was prohibited in France in 1990 and we studied the haemodynamic effect of a structural analogue marketed in France, lysine-vasopressin infused locally at the operative field.
Methods: Four haemodynamic parameters were evaluated in 7 patients undergoing surgery via the vaginal route under epidural anaesthesia (lidocaine 2%). Arterial pressure and heart rate were measured noninvasively and thoracic bioimpedance was used for measuring cardiac index and systemic vascular resistance. Baseline levels were obtained after induction of anaesthesia and positioning the patient. Five units of lysine-vasopressin diluted in 20 ml of 9/1000 saline solution were infused locally into the cervix. Haemodynamic measures were made for 15 minutes.
Results: Five minutes after infusion, there was a significant increase in systolic (+21 +/- 7%) and diastolic (+29 +/- 9%) arterial pressure (p < 0.05) (Mann and Whitney U test). There was a tendency for bradycardia which did not reach significance. The systemic arterial resistances were increased from 3080 +/- 178 to 4965 +/- 227 ohm/m3 with concomitant drom in systolic index from 2.6 +/- 0.3 to 1.6 +/- 0.11 min/m2. The observed haemodynamic effects were similar to those obtained with onipressin and corresponded to a sudden increase in post-charge. Cardiac tolerance was poor with a drop in systolic index to a level corresponding to a fall in cardiac inotropism and coronary blood flow.
Conclusion: With this product, the patients are exposed to the same diseases and accidents described for ornipressin and thus should be used with extreme care, in adapted situations by competent experienced surgeons for patients without cardiovascular or cerebral diseases.