Cardiovascular Collapse in Anaphylaxis Successfully Treated With Vasopressin: Case Report and Review of Mechanism

Abstract

In this report, we describe the case of a 52-year-old man who suffered a severe anaphylactic reaction in the operating room that was unresponsive to epinephrine. After an uneventful induction and intubation, he received antibiotics and was placed in the prone position. His blood pressure began to decline and despite escalating doses of phenylephrine, ephedrine, and then epinephrine, his pressure continued to deteriorate and became unobtainable. When all other resuscitative measures failed, a single dose of vasopressin 20 units was given intravenously; the patient had an immediate response with dramatic reversal of the cardiovascular collapse. He was then stabilized, transferred to the ICU, and subsequently discharged home without neurologic sequelae. In this article, we review the signs and symptoms of anaphylaxis seen in patients under anesthesia and consider the pathophysiologic mechanisms of the reaction that support the use of vasopressin.