Role of vasopressin in current anesthetic practice.
10.4097/kjae.2017.70.3.245
- Author:
Keun Suk PARK
1
;
Kyung Yeon YOO
Author Information
1. Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Korea. kyyoo@jnu.ac.kr
- Publication Type:Review
- Keywords:
Arginine vasopressin;
Hemorrhagic shock;
Refractory hypotension;
Septic shock;
Terlipressin;
Vasodilatory shock
- MeSH:
Arginine Vasopressin;
Cardiopulmonary Bypass;
Catecholamines;
Esophageal and Gastric Varices;
Heart Arrest;
Hemorrhage;
Humans;
Hypotension;
Muscle, Smooth, Vascular;
Plasma;
Renal Circulation;
Renin-Angiotensin System;
Sepsis;
Shock;
Shock, Hemorrhagic;
Shock, Septic;
Vasoconstriction;
Vasopressins*
- From:Korean Journal of Anesthesiology
2017;70(3):245-257
- CountryRepublic of Korea
- Language:English
-
Abstract:
Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V₁ receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP (‘relative vasopressin deficiency’) and supersensitivity to exogenously-administered AVP. Low doses of AVP and its synthetic analog terlipressin can restore vasomotor tone in conditions that are resistant to catecholamines, with preservation of renal blood flow and urine output. They are also useful in the treatment of refractory arterial hypotension in patients chronically treated with renin-angiotensin system inhibitors, cardiac arrest, or bleeding esophageal varices. In the perioperative setting, they represent attractive adjunct vasopressors in advanced shock states that are unresponsive to conventional therapeutic strategies.
