Korean J Anesthesiol.  2017 Jun;70(3):245-257. 10.4097/kjae.2017.70.3.245.

Role of vasopressin in current anesthetic practice

• Park KS
• Yoo KY

• KMID: 2382741
• DOI: http://doi.org/10.4097/kjae.2017.70.3.245

Abstract

Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V₁ receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP ("˜relative vasopressin deficiency') and supersensitivity to exogenously-administered AVP. Low doses of AVP and its synthetic analog terlipressin can restore vasomotor tone in conditions that are resistant to catecholamines, with preservation of renal blood flow and urine output. They are also useful in the treatment of refractory arterial hypotension in patients chronically treated with renin-angiotensin system inhibitors, cardiac arrest, or bleeding esophageal varices. In the perioperative setting, they represent attractive adjunct vasopressors in advanced shock states that are unresponsive to conventional therapeutic strategies.

Keyword

Arginine vasopressin; Hemorrhagic shock; Refractory hypotension; Septic shock; Terlipressin; Vasodilatory shock

MeSH Terms

Arginine Vasopressin
Cardiopulmonary Bypass
Catecholamines
Esophageal and Gastric Varices
Heart Arrest
Hemorrhage
Humans
Hypotension
Muscle, Smooth, Vascular
Plasma
Renal Circulation
Renin-Angiotensin System
Sepsis
Shock
Shock, Hemorrhagic
Shock, Septic
Vasoconstriction
Vasopressins*
Arginine Vasopressin
Catecholamines
Vasopressins