Bradycardia and severe vasospasm caused by intramyometrial injection of vasopressin during myomectomy

Vasopressin is often used locally to reduce blood loss during surgery. Vasopressin has longest clinical effect, but its systemic effects may be profound and pose significant challenges for the anesthesiologist and it can also sometimes cause lethal complications. The loss of peripheral pulse along with bradycardia, non-measurable arterial blood pressure, and cardiac complications have been reported after myometrial injection of vasopressin. Here, we describe a patient with multiple uterine myomas who developed severe bradycardia, non-measurable blood pressure by non-invasive means and loss of peripheral pulse after myometrial injection of vasopressin at a total dose of 20 units [1 unit/ml] with documentation of severe peripheral arterial vasospasm and increased proximal blood pressure. The patient was successfully resuscitated

analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: a randomized controlled study

Transversus abdominis plane [TAP] block is suitable for lower abdominal surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound [USG]-guided TAP block for retroperitoneoscopic donor nephrectomy [RDN]. In a prospective randomized double-blind study, 60 patients undergoing laparoscopic donor nephrectomy were randomly divided into two groups by closed envelope method. At the end of surgery, USG-guided TAP block was given to the patients of both the groups. Study group [group S] received inj. Bupivacaine [0.375%], whereas control group [group C] received normal saline. Inj. Tramadol [1 mg/kg] was given as rescue analgesic at visual analog scale [VAS] more than 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS both at rest and on movement, time to first dose of rescue analgesic, cumulative dose of tramadol, sedation score, and nausea score, which were also noted at 30 min, 2, 4, 6, 12, 18, and 24 h postoperatively. Total tramadol consumption at 24 h was also assessed. Patients in group S had significantly lower VAS score, longer time to first dose of rescue analgesic [547.13 +/- 266.96 min vs. 49.17 +/- 24.95 min] and lower tramadol consumption [103.8 +/- 32.18 mg vs. 235.8 +/- 47.5 mg] in 24 h. The USG-guided TAP block is easy to perform and effective as a postoperative analgesic regimen in RDN, with opioids-sparing effect and without any complications