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Vasopressin for treatment of shock following aprotinin administration

[Traitement à la vasopressine pour un choc suivant l’administration d’aprotinine]

Stephan R. Williams, MD PhD^*, André Y. Denault, MD FRCPC^*, Michel Pellerin, MD FRCSC and Raymond Martineau, MD FRCPC^*

^* From the Departments of Anesthesiology, and
Heart Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.

Address correspondence to: Dr. André Y. Denault, Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada. Phone: 514-376-3330, ext. 3709; Fax: 514-376-8784; E-mail: denault{at}videotron.ca

Purpose: To describe the utility of vasopressin in the treatment of acute distributive shock clinically compatible with the diagnosis of aprotinin anaphylaxis.

Clinical features: A 57-yr-old female patient underwent repeat cardiac surgery to treat prosthetic valve endocarditis. She had received aprotinin during her first surgery 60 days ago. Despite a negative test dose of iv aprotinin 20,000 KIU, when aprotinin loading was initiated during the repeat surgery, the patient developed bronchospasm and hypotension secondary to acute distributive shock. Bronchospasm responded to inhaled salbutamol and ipatropium. The hypotension was refractory to high doses of phenylephrine. Two doses of iv vasopressin 5 U reversed the vasodilation and reestablished normal blood pressure.

Conclusion: Vasopressin, in association with alpha-agonists, can reverse acute refractory distributive shock following aprotinin administration.

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