Abstract
Objective: Our aim is comparison of hemodynamic status and complications between two different doses of intramyometrial vasopressin during laparoscopic myomectomy. Methods: We did a retrospective analysis of hemodynamic status and its anesthetic concerns in patients who received two different doses of intramyometrial vasopressin. Eighty patients undergoing laparoscopic myomectomy under general anesthesia were divided into two groups of 40 patients in each group. In Group A (n=40), 10 units of intramyometrial vasopressin in 200 ml of normal saline were given and, in Group B, 20 units of intramyometrial vasopressin in 200 ml of NS were given intraoperatively by surgeon. Results: 20 units intramyometrial vasopressin used dogmatically by surgeons drops blood loss but it is connected with cardiovascular impediments. Hence, 10 units of intramyometrial vasopressin as compared to 20 units which are used by some surgeons are associated with similar blood loss and lesser side effects such as bradycardia, pulmonary edema, hypotension, blood loss, and increased airway pressure. Conclusion: Hence, anesthesiologists and gynecologists must take the precautions to escape and minimize the frequency of impediments with intramyometrial vasopressin by selecting the appropriate dosage of vasopressin.
Highlights
Uterine leiomyoma is the most extensively recognized sort of pelvic tumors in women [1].When a uterine myoma creates, the ordinary life systems of uterine veins are disturbed, and the vessels run in unusual ways
The variations in heart rate (HR) and blood pressure after intramyometrial vasopressin injection might be correlated to the systemic absorption of vasopressin especially during the surgical excisions of the fibroid and not linked to the direct intravascular injection
Bradycardia and hypotension occurred in 50% of Group B patients as compared to 20% in Group A patients with *p-=0.034 which is statistically significant
Summary
Uterine leiomyoma is the most extensively recognized sort of pelvic tumors in women [1].When a uterine myoma creates, the ordinary life systems of uterine veins are disturbed, and the vessels run in unusual ways. Intramyometrial infusion of vasopressin causes vasoconstriction, stimulates the uterine contractions and it reduces the blood loss during surgery [4,5]. The injection of diluted vasopressin into the plane between the myoma and myometrium leads to vasoconstriction of the feeding vessels for 45–60 min which is usually sufficient for the myometrial suturing to be accomplished and reducing the blood flow to the myoma and lessening the blood loss during the excision of the myoma [10,11,12]. There are discussions and encounters between the surgeons and anesthesiologists regarding the risks and advantages of vasopressin and this study was conducted to evaluate the incidence of cardiovascular complications associated with the intramyometrial injection of vasopressin. Our aim here is to look for the changes in hemodynamic status and complications after two different doses of intramyometrial vasopressin and to look for any difference in blood loss in both groups
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