Case report: Severe vasospasm mimics hypotension after high-dose intrauterine vasopressin

Anesth Analg. 2011 Nov;113(5):1103-5. doi: 10.1213/ANE.0b013e31822cef10. Epub 2011 Aug 24.


Intramyometrial vasopressin injection reduces bleeding during myomectomy. Subsequent loss of peripheral pulses and nonmeasurable arterial blood pressure have been attributed to cardiovascular collapse or hypotension. When interpreted as global hypotension, treatment with vasopressors or according to Advanced Cardiac Life Support resuscitation protocols has been associated with cardiac complications. We describe a patient who developed loss of peripheral pulses and nonmeasurable blood pressure by noninvasive means after myometrial administration of 60 U vasopressin, with documented severe peripheral arterial vasospasm and elevated proximal blood pressure. We discuss the pathophysiology and emphasize the danger of misinterpreting pulselessness as global hypotension instead of vasospasm in this setting.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anesthesia, General
  • Blood Pressure
  • Brachial Artery / diagnostic imaging
  • Brachial Artery / drug effects
  • Female
  • Hemodynamics / physiology
  • Humans
  • Injections
  • Leiomyoma / surgery
  • Myometrium
  • Peripheral Arterial Disease / chemically induced*
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / diagnostic imaging
  • Radial Artery / diagnostic imaging
  • Radial Artery / drug effects
  • Ultrasonography
  • Uterine Neoplasms / surgery
  • Vasoconstrictor Agents / administration & dosage
  • Vasoconstrictor Agents / adverse effects*
  • Vasopressins / administration & dosage
  • Vasopressins / adverse effects*


  • Vasoconstrictor Agents
  • Vasopressins