Vassopresin in Spinal Anaesthesia.. dangerous ???

When my  surgeon does a myomectomy an open one and if the tumor is large they used to tie the uterus with a infant feeding tube and the bleeding is less. So at the end of surgery when the tie is opened everything is fine in most cases.

                  Then came an era when he started to use Vasopressin diluted ( 20 IU diluted to 50 ml ). He injects the solution to uterus around the tumor. The parts become visibly white meaning severe vasoconstriction only around the tumour not the whole uterus. When vasopressin is ad ministered there is some cardio vascular disturbances in the form of various types of arrhythmia.

Mostly sinus Brady cardia, dropped heart beats. Extra systole, heart block with mild to severe hypotension in many patients.There we found a difference when the patient is under General Anaesthesia and spinal anaesthesia.   Of about nearly 75 cases in Spinal Anaesthesia and about 30 in General anaesthesia. the cardio Vascular effect were remarkable under spinal Anaesthesia. In most cases there was severe brady cardia coupled with hypotension of varying degree and needed an injection of Atropine ( 1 to 2 amps ) in almost all cases. Where as  under General anaesthesia hardly 5-6 cases needed any supportive treatment.
                 Now adays my surgeon after procuring a mercillator hardly going for open surgery. All cases ( single, multiple tumour ) and tumour size varying from 2 cm to 20 cm are removed Laparoscopicaaly and he uses an injection of Vassopressin to reduce vascularity of the tumour and freduced bleeding. The uterus is stiched with a suture that automatically tightens and needs no tying.
                 And I am  very releived as most cases are done under GA. Though there are case reports that Cardiac arrest has occured during use of Vassopressin under Lap surgery and removal of Myoma. What is important is watchfullness.



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