Vasopressin for the Management of Catecholamine-Resistant Anaphylactic Shock

Singapore Med J. 2008 Sep;49(9):e225-8.

Abstract

Severe anaesthetic anaphylaxis is relatively uncommon. Oxygen, fluids and epinephrine are considered to be the mainstay for treatment of cardiovascular collapse and current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of a cardiovascular collapse. Recently, evidence has emerged in the support of the use of vasopressin in cardiopulmonary resuscitation; it is also recommended for the treatment of ventricular fibrillation, septic shock and post-cardiopulmonary bypass distribution shock. Currently, there is no algorithm or guideline for the management of anaphylaxis that include the use of vasopressin. We report a 24-year-old woman who developed severe anaphylactic shock at induction of anaesthesia while undergoing laparoscopic cholecystectomy. Circulation shock was refractory to epinephrine and high doses of pure alpha-agonist phenylephrine and norepinephrine. Single intravenous dose of two units of vasopressin re-established normal circulation and blood pressure.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Algorithms
  • Anaphylaxis / chemically induced*
  • Anaphylaxis / drug therapy*
  • Blood Pressure
  • Catecholamines / therapeutic use*
  • Cholecystectomy / methods
  • Drug Resistance
  • Epinephrine / pharmacology
  • Female
  • Humans
  • Norepinephrine / pharmacology
  • Phenylephrine / pharmacology
  • Treatment Outcome
  • Vasoconstrictor Agents / therapeutic use*
  • Vasopressins / therapeutic use*

Substances

  • Catecholamines
  • Vasoconstrictor Agents
  • Vasopressins
  • Phenylephrine
  • Norepinephrine
  • Epinephrine