Intensive Care Medicine

, Volume 14, Issue 5, pp 526–531 | Cite as

The physiological effects of vasopressin when used to control intra-abdominal bleeding

  • M. P. Shelly
  • R. Greatorex
  • R. Y. Calne
  • G. R. Park
Original Articles

Abstract

Vasopressin was used in ten critically ill patients with massive intra-abdominal bleeding unresponsive to conventional therapy. Vasopressin controlled bleeding in four patients, three of whom had continued to bleed following laparotomy for haemostasis; in two other patients, bleeding was reduced. All the patients were intensively monitored throughout the period of the vasopressin treatment; this enabled other physiological effects of vasopressin to be documented and reported. Mean arterial pressure and central venous pressure increased following the administration of vasopressin and there was a decrease in heart rate. Core body temperature rose significantly. Although all the patients had impaired renal function before receiving vasopressin, five had a prompt diuresis following its administration. Eight patients died but only three of intra-adbominal bleeding; two patients survived to leave hospital. Four patients had post-mortem evidence of ischaemia in the heart, liver and gastrointestinal tract; vasopressin may have contributed to the development of this. Vasopressin may have a place in the management of patients with life-threatening intra-abdominal haemorrhage but its use should be confined to those patients in whom conventional therapy has failed.

Key words

Vasopressin Abdominal bleeding Cardiovascular measurements Renal failure 

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References

  1. 1.
    Clark GA (1928) Comparison of the effects of adrenalin and pituitrin on the portal circulation. J Physiol 66:274Google Scholar
  2. 2.
    Melson GL, Geisse G, Stanley RJ (1976) Selective intraarterial infusion of vasopressin for control of gastrointestinal bleeding: experience with 35 cases. Gastrointest Radiol 1:59Google Scholar
  3. 3.
    Millette B, Huet P-M, Lavoie P, Viallet A (1975) Portal and systemic effects of selective infusion of vasopressin into the superior mesenteric artery in cirrhotic patients. Gastroenterology 69:6Google Scholar
  4. 4.
    Barr JW, Lakin RC, Rosch J (1975) Similarity of arterial and intravenous vasopressin on portal and systemic hemodynamics. Gastroenterology 69:13Google Scholar
  5. 5.
    Johnson WC, Wildrich WC, Ansell JE, Robbins AH, Nabseth DC (1977) Control of bleeding varces by vasopressin: a prospective randomised study. Ann Surg 186:369Google Scholar
  6. 6.
    Shaldon S, Sherlock S (1960) The Use of Vasopressin (Pitressin) in the control of bleeding from oesophageal varices. Lancet II:222Google Scholar
  7. 7.
    Kehne JH, Hughes FA, Gompertz ML (1956) The use of surgical pituitrin in the control of esophageal varix bleeding. Surgery 39:917Google Scholar
  8. 8.
    Conn HO, Dalessio DJ (1962) Multiple infusions of posterior pituitary extract in the treatment of bleeding esophageal varices. Ann Intern Med 57:805Google Scholar
  9. 9.
    Hussey KP (1985) Vasopressin therapy for upper gastrointestinal tract hemorrhage. Arch Intern Med 145:1263Google Scholar
  10. 10.
    Eiseman B, Silen W, Tyler P, Earley T (1960) The portal hypotensive action of pituitrin. Surgical Forum 10:286Google Scholar
  11. 11.
    Drapanas T, Crowe CP, Shim WKT, Worthington GS (1961) The effect of pitressin on cardiac output and coronary, hepatic and intestinal blood flow. Surg Gynecol Obstet:484Google Scholar
  12. 12.
    Nusbaum M (1975) Arterial vasopressin infusions: science or seance? Gastroenterology 69:263Google Scholar
  13. 13.
    Silva YJ, Moffat RC, Walt AJ (1969) Vasopressin effect on portal and systemic hemodynamics. JAMA 210:1065Google Scholar
  14. 14.
    Shelly MP, Robinson AA, Hesford JW, Park GR (1987) The haemodynamic effects following surgical release of raised intraabdominal pressure. Br J Anaesth 59:800Google Scholar
  15. 15.
    Edmunds R, West JP (1962) A study of the effect of vasopressin on portal and systemic blood pressure. Surg Gynaecol Obstet 459Google Scholar
  16. 16.
    Bynum TE, Fara JW (1980) Hepatic artery response to vasopressin. Am J Physiol 239:378Google Scholar
  17. 17.
    Hanson KM (1970) Vascular response of intestine and liver to intravenous infusion of vasopressin. Am J Physiol 219:779Google Scholar
  18. 18.
    Greenaway CV (1983) Role of splanchnic venous system in overall cardiovascular homeostasis. Fed Proc 42:1678Google Scholar
  19. 19.
    Slotnik IL, Tiegland JD (1951) Cardiac accidents following Vasopressin injection (Pitressin). JAMA 146:1126Google Scholar
  20. 20.
    Ruskin A (1947) Pitressin test of coronary insufficiency. Am J Heart 34:569Google Scholar
  21. 21.
    Roberts C, Maddison FE (1976) Partial mesenteric arterial occlusion with subsequent ischaemic bowel damage due to Pitressin infusion. Am J Roentgenol 126:829Google Scholar
  22. 22.
    Beradi RS (1974) Vascular complications of superior mesenteric artery infusion with Pitressin in treatment of bleeding varices. Am J Surg 127:757Google Scholar
  23. 23.
    Renert WA, Button KF, Fuid SL, Casarella WJ (1972) Mesenteric venous thrombosis and small bowell infarction following infusion of vasopressin into the superior mesenteric artery. Radiology 102:299Google Scholar
  24. 24.
    Collins EN, Root JC (1936) Elimination of confusing gas shadows during cholecystography by the use of Pitressin. JAMA 107:32Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • M. P. Shelly
    • 1
  • R. Greatorex
    • 1
  • R. Y. Calne
    • 1
  • G. R. Park
    • 1
  1. 1.Addenbrooke's HospitalCambridgeUK

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