The effect of vasopressin on local and general circulation during laparoscopic surgery.

STUDY OBJECTIVE

To study local and general circulation after vasopressin administration during laparoscopic surgery.

DESIGN

Prospective analysis (Canadian Task Force classification II-1).

SETTING

University-affiliated hospital.

PATIENTS

Nine patients who underwent laparoscopic myomectomy (LM) from March through December 2003.

INTERVENTION

Transvaginal ultrasound and transesophageal ultrasound were performed to evaluate blood flow of the uterine artery and the descending aorta, respectively, during laparoscopic surgery.

MEASUREMENTS AND MAIN RESULTS

Nine patients who had a low number (one to two) of uterine myomas in the anterior wall underwent LM with local administration of four units of 100-fold diluted vasopressin. We monitored blood flow of the ascending branch of the uterine artery and measured the resistance index (RI) value by transvaginal ultrasound. The decreasing reaction of diastole blood flow was fast, and the median time required until disappearance of signal was 4 minutes (range 1-8 minutes). We monitored blood flow of the descending aorta by transesophageal ultrasound and compared the results with eight control patients who did not receive vasopressin. Urine volume was measured during the surgery and postoperatively. No significant difference in descending aortic blood flow volume, and intraoperative and postoperative urine volume was found between the two groups. Systolic/diastolic blood pressure tended to increase immediately after vasopressin administration, but the increase was not significant.

CONCLUSIONS

Local administration of vasopressin to the uterus is a safe and effective hemostatic technique for controlling regional blood flow from the uterine artery to peripheral vessels without having a significant effect on systemic circulatory dynamics.