LOCAL INFUSION OF LYSINE-VASOPRESSIN IN G YNECOLOGY SURGERY

Objectives: Vasoconstrictors are often used in gynaecology for vaginal surgery. Ornipressin was prohibited in France in 1990 and we studied the haemodynamic effect of a structural analogue marketed in France, l ysine-vasopressin infused locally at the operative field. Methods: Fou r haemodynamic parameters were evaluated in 7 patients undergoing surg ery via the vaginal route under epidural anaesthesia (lidocain 2%). Ar terial pressure and heart rate were measured nonivasively and thoracic bioimpedance was used for measuring cardiac index and systemic vascul ar resistance, Baseline levels were obtained after induction of anaest hesia and positioning the patient. Five units of lysine-vasopressin di luted in 20 ml of 9 parts per thousand saline solution were infused lo cally into the cervix. Haemodynamic measures were made for 15 minutes. Results: Five minutes after infusion, there was a significant increas e in systolic (+21+/-7%) and diastolic (+29+/-9%) arterial pressure (p <0.05) (Mann and Whitney U test). There was a tendancy for bradycardia which did not reach significance. The systemic arterial resistances w ere increased from 3080+/-178 to 4965+/-227 ohm/m(3) with concomitant drom in systolic index from 2.6+/-0.3 to 1.6+/-0.11 min/m(2). The obse rved haemodynamic effects were similar to those obtained with onipress in and corresponded to a sudden increase in post-charge. Cardiac toler ance was poor with a drop in systolic index to a level corresponding t o a fall in cardiac inotropism and coronary blood now. Conclusion: Wit h this product, the patients are exposed to the same diseases and acci dents described for ornipressin and thus should be used with extreme c are, in adapted situations by competent experienced surgeons for patie nts without cardiovascular or cerebral diseases.