• Logo
  • SBMUJournals

Effect of Prophylactic Vasopressin on Hemodynamic Parameters after Coronary Artery Bypass Graft Surgery

Alireza Jahangirifard, Majid Golestani Eraghi, Kamal Fani, Arash Tafrishinejad, Niloufar Dadashpour, Zargham Hossein Ahmadi, shirin salagegheh
302

Views

PDF

Abstract

Background: As common complications of Coronary artery bypass grafting (CABG), low vascular resistance and hypotension could be life threatening . The aim of present study was to investigate the effect of low-dose vasopressin on hemodynamics in CABG patients.

Material &Methods: In this randomized double-blinded clinical trial, 80 patients undergoing selective CABG were randomly divided into two equal case and control groups (n=40). Case group was received vasopressin 0.03 IU/min 30 minute before the end of cardio-pulmonary bypass (CPB) until one hour after that. Control group was received normal saline in the same manner. Dopamine

 requirement, ICU stay, heart rate (HR), mean arterial blood pressure (MAP), central venues pressure (CVP) and atrial blood acidity (PH) were recorded and compared between groups  in 5 phases ( 0,30,60,90,120 min) after separation of CPB.

Results: There was no significant difference between two groups in number of patients with severe hypotension (11 vs. 12 patients in case and control group respectively). CVP was corrected and then dopamine administration was compared in both group. In vasopressin and placebo group, 3 vs 11 patients need to dopamine administration immediately after separation from CPB (p= 0.018) and 4 vs 12 patients later in ICU (p=0.024) respectively. The mean needed dose of dopamine in vasopressin and placebo group immediately after separation from CPB were 7.63±3.42 vs 9.21±2.08 µg/kg/min (p=0.031) and later in ICU were 7.42±2.02 vs 8.66±4.08 µg/kg/min (p=0.045) respectively, which was significantly lower in vasopressin group in comparison with placebo group.

Conclusion: Based on our results low-dose vasopressin administration significantly reduced the mean needed dose of required dopamine, 24 hours urinary output, Duration of mechanical ventilation and patient’s heart rate.


Keywords

vasopressin, hemodynamic parameters, CABG

References

- Ozal E, Kuralay E, Yildirim V, Kilic S, Bolcal C, Kucukarslan N, Gunay C, Demirkilic U, Tatar H. Preoperative methylene blue administration inpatients at high risk for vasoplegic syndrome during cardiac surgery. Ann ThoracSurg 2005; 79:1615-9.

- Sun X, Zhang L, Hill PC, Lowery R, Lee AT, Molyneaux RE, Corso PJ, and Boyce SW: Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery?

- Noto A, Lentini S, Versaci A, Giardina M, Risitano DC, Messina R, David A: A retrospective analysis of terlipressin in bolus for the management of refractory vasoplegic hypotension after cardiac surgery. InteractCardioVascular and Thoracic Surgery 2009, 9:588-92.

- Papadopoulos G, Sintou E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E. Perioperative infusion of low dose of vasopressin for prevention and management of vasodilatoryvasoplegic syndrome in patients undergoing coronary artery bypass grafting: A double-blind randomized study. J CardiothoracSurg 2010; 5:17.

- Albright TN, Zimmerman MA, Selzman CH. Vasopressin in the cardiac surgery intensive care unit. Am J Crit Care. 2002; 11:326–32.

- Elgebaly AS, Sabry M: Infusion of low-dose vasopressin improves left ventricular function during separation from cardiopulmonary bypass: a double-blind randomized study. Ann Card Anaesth 2012, 15:128–133.

- Mayr VD, Wenzel V, Müller T, Antretter H, Rheinberger K, Lindner KH, Strohmenger HU: Effects of vasopressin on left anterior descending coronary artery blood flow during extremely low cardiac output. Resuscitation 2004, 62:229–235.

- Morales DL, Garrido MJ, Madigan JD, et al: A double-blind randomized trial: prophylactic vasopressin reduces hypotension after cardiopulmonary bypass[J]. Ann ThoracSurg 2003, 75:926–930.

- Yimin H, Xiaoyo L, Yuping H, Weiyan L, Ning L. The effect of vasopressin on the hemodynamics in CABG patients. J Cardiothorac Surg. 2013; 8:49.

- Elgebaly AS, Sabry M. Infusion of low-dose vasopressin improves left ventricular function during separation from cardiopulmonary bypass: a double-blinded randomized study. Annals of Cardiac Anaesthesia. 2012; 15(2): 128-133.

- Shanmugam G: Vasoplegic syndrome-the role of methylene blue. Eur J Cardio-thoracic Surg. 2005, 28:705-10.

- Argenziano M, Chen J, Choundhri A, Cullinane S, Garfein E, Weinberg AD, Smith CR Jr, Rose EA, Landry DW, Oz MC: Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J ThoracCardiovascSurg 1998, 116:973-80.

- Patel B, Chittock D, Russell J, Walley K: Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002, 96:576-82.

- Suojaranta-Ylinen R, Vento R, Patila T, Kukkonen S: Vasopressin, when added to norepinephrine, was not associated with increased predicted mortality after cardiac surgery. Scand J Surg 2007, 96:314-18.

- Morales D, Gregg D, Helman D, Williams MR, Naka Y, Landry DW, Oz MC: Arginine vasopressin in the treatment of fifty patients with postcardiotomyvasodilatory shock. Ann ThoracSurg 2000, 69:102-6.




DOI: https://doi.org/10.22037/jcma.v2i3.15315

Refbacks

  • There are currently no refbacks.