Arginine vasopressin as a rescue vasopressor to treat epidural anaesthesia-induced arterial hypotension

Epidural anaesthesia is a well-established and recognized technique in anaesthetic practice. Its benefits are multiple and range from positive effects on the respiratory and cardiocirculatory system, a reduced need for analgesics and decreased costs to earlier hospital discharge. Disadvantages like sympathetic blockade followed by hypotension, bradycardia, and cardiac arrest, however, must be taken into consideration. Treatment of these side effects consists of fluid infusion and vasopressor drugs. During epidural anaesthesia, plasma arginine vasopressin (AVP) concentrations are increased. In case reports and a small clinical study, administration of AVP or one of its analogues could rapidly reverse hypotension and restore cardiovascular stability. Because no major controlled clinical trial has yet evaluated the effects of AVP on morbidity, AVP can so far not be recommended as a first-line drug to treat cardiovascular instability during epidural anaesthesia. In refractory cases, however, the use of AVP as a rescue vasopressor may be beneficial.