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Hemodynamic responses to desmopressin acetate after CABG: a double-blind trial
M Salmenperä1, A Kuitunen, M Hynynen
1Department of Anesthesia, Helsinki University Central Hospital, Finland.
Insights
Desmopressin acetate (DDAVP) administration in cardiac surgery patients can cause dangerous hypotension, with no proven benefit in reducing bleeding. This study found significant drops in mean arterial pressure after DDAVP infusion.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Cardiac surgical patients often receive desmopressin acetate (DDAVP) post-cardiopulmonary bypass (CPB) to manage bleeding.
- While DDAVP's side effects are typically considered minor, severe hypotension has been reported.
Purpose of the Study:
- To investigate the hemodynamic effects of DDAVP in patients undergoing coronary artery bypass grafting (CABG).
- To assess the safety and efficacy of routine DDAVP use in this patient population.
Main Methods:
- A randomized, double-blind, placebo-controlled study.
- 15 patients received DDAVP (0.3 mcg/kg over 15 min), and 15 received saline placebo after skin closure.
- Hemodynamic parameters, including mean arterial pressure (MAP) and systemic vascular resistance, were monitored.
Main Results:
- A statistically significant decrease in MAP was observed starting 5 minutes after DDAVP initiation, with maximum reduction occurring at the end of infusion (mean change -21 +/- 8 mm Hg).
- Hypotension was linked to a decrease in systemic vascular resistance.
- No significant difference in postoperative blood loss was found between the DDAVP and placebo groups.
Conclusions:
- Routine DDAVP administration in CABG patients is not advisable due to potentially dangerous hemodynamic side effects.
- The therapeutic benefit of DDAVP in preventing or controlling bleeding diathesis in this context is unlikely.
Abstract:
Despite controversial results concerning its effectiveness, cardiac surgical patients commonly receive desmopressin acetate (DDAVP) after cardiopulmonary bypass (CPB) in an effort to prevent or control bleeding diathesis. The side effects associated with DDAVP are usually considered benign. However, numerous authors have observed episodes of severe hypotension after DDAVP. As a part of a larger trial of DDAVP in routine first-time coronary artery bypass grafting (CABG), this randomized double-blind study of the hemodynamic effects of DDAVP was performed. Fifteen patients received DDAVP (0.3 microgram/kg over 15 minutes) and another 15 received saline placebo after skin closure. A statistically significant decrease in mean arterial pressure (MAP) was observed at 5 minutes after the beginning of DDAVP administration and the maximum decrease (mean change, -21 +/- 8 mm Hg, P less than 0.001) was reached as the infusion was completed. MAP did not change significantly in the control group. Hypotension after DDAVP was associated with a corresponding decrease in systemic vascular resistance. Postoperative blood loss was not different between the groups. It is concluded that routine administration of DDAVP to CABG patients is inadvisable because hemodynamic side effects are potentially dangerous and therapeutic benefit is highly unlikely.