Vasopressin in perioperative management of congenital diaphragmatic hernia

Abstract

Perioperative care of infants with diaphragmatic hernias can be a challenge because of pulmonary hypertension and systemic hypotension. The objective of this study was to report the usefulness of vasopressin infusion in improving pulmonary and systemic haemodynamics in an infant with congenital diaphragmatic hernia. Oxygenation failure, pulmonary hypertension and refractory systemic hypotension in infants with diaphragmatic hernia are managed by ventilation and conventional inotropes (dobutamine and dopamine). Vasopressin is a recent addition that exerts vasodilatory effects on the pulmonary circulation and vasotonic effects on the systemic circulation. The net effect is a reduction in pulmonary vascular resistance and improvement in cardiac output and reduced need for inotropes. This paradoxical response (vasodilation in some vascular beds) distinguishes it from other vasoconstrictor agents. The infant was administered intravenous vasopressin infusion for severe pulmonary hypertension that needed inhaled nitric oxide and for systemic hypotension that needed multiple inotropes under close echocardiographic monitoring. Informed parental consent and appropriate institutional ethics approval were obtained. Addition of vasopressin led to improved oxygenation and weaning off from nitric therapy. Improvement in cardiac output and blood pressure facilitated the weaning off from inotropes. Close echocardiographic monitoring was performed to ascertain the haemodynamic effects of vasopressin. Under echocardiographic monitoring, vasopressin is a useful adjunct for managing pulmonary and systemic perioperative haemodynamic instability in infants with diaphragmatic hernia.Keywords: congenital diaphragmatic hernia, echocardiography, vasopressin