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Vasopressin as adjunct vasopressor for vasodilatory shock due to non-occlusive mesenteric ischemia

Vasopressin als zusätzlicher Vasopressor bei vasodilatorischem Schock aufgrund einer nichtokklusiven mesenterialen Ischämie

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Abstract

We present the case of an 83-year-old patient who underwent cardiac surgery and developed postoperative non-occlusive mesenteric ischemia (NOMI), which was treated with a local intra-arterial papaverine and prostaglandin E1 infusion. After successful mesenteric reperfusion, a multiple organ dysfunction syndrome with severe cardiovascular failure developed. High norepinephrine dosages (1.09 µg/kg body weight/min) and catecholamine-related complications (tachycardiac atrial fibrillation) required initiation of supplementary argininevasopressin (AVP) infusion (4 U/h). AVP stabilized vasodilatory shock, ensured adequate gut perfusion pressure and had no adverse clinical or angiographic effects on restitution of gut integrity. In conclusion, after reperfusion of NOMI in this patient, adjunct AVP therapy combined with local vasodilator infusion was beneficial as a potentially life-saving vasopressor.

Zusammenfassung

Wir berichten über einen 83-jährigen Mann, der nach einem kardiochirurgischen Eingriff eine nichtokklusive mesenteriale Ischämie (NOMI) entwickelte, die mit einer lokalen intraarteriellen Infusion mit Papaverin und Prostaglandin E1 behandelt wurde. Nach erfolgreicher mesenterialer Reperfusion entwickelte sich ein Multiorgandysfunktionssyndrom mit schwerem Herzkreislaufversagen. Hohe Noradrenalindosen (1,09 µg/kgKG/min) und katecholamininduzierte Komplikationen (tachykardes Vorhofflimmern) erforderten eine zusätzliche Arginin-Vasopressin- (AVP-)Infusion. Arginin-Vasopressin stabilisierte den vasodilatorischen Schock, sicherte einen adäquaten Perfusionsdruck des Darms und hatte keine negativen klinischen oder angiographischen Auswirkungen auf die Erholung der Darmintegrität. Zusammenfassend erwies sich bei diesem Patienten nach Reperfusion einer NOMI AVP in Kombination mit Noradrenalin und lokaler Vasodilatatorinfusion als potenziell lebensrettender Vasopressor.

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria

    G. Luckner, S. Jochberger, V. D. Mayr, H. Knotzer, W. Pajk, V. Wenzel, B. Friesenecker, I. Lorenz & M. W. Dünser

  2. Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    G. Luckner

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  1. G. Luckner
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  2. S. Jochberger
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  3. V. D. Mayr
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  4. H. Knotzer
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  5. W. Pajk
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  6. V. Wenzel
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  7. B. Friesenecker
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  8. I. Lorenz
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  9. M. W. Dünser
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Correspondence to G. Luckner.

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Luckner, G., Jochberger, S., Mayr, V.D. et al. Vasopressin as adjunct vasopressor for vasodilatory shock due to non-occlusive mesenteric ischemia. Anaesthesist 55, 283–286 (2006). https://doi.org/10.1007/s00101-005-0958-3

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  • DOI: https://doi.org/10.1007/s00101-005-0958-3

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