Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial.

Autor: Cohen SL; Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Senapati S; Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA., Gargiulo AR; Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA., Srouji SS; Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA., Tu FF; Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA., Solnik J; Cedars Sinai Medical Center, Los Angeles, CA, USA., Hur HC; Beth Israel Deaconess Medical Center, Boston, MA, USA., Vitonis A; Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Jonsdottir GM; Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Wang KC; Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Einarsson JI; Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2017 Jan; Vol. 124 (2), pp. 262-268. Date of Electronic Publication: 2016 Jun 30.
DOI: 10.1111/1471-0528.14179
Abstrakt: Objective: To determine if higher-volume, fixed-dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy.
Design: Randomised multicentre clinical trial.
Setting: Tertiary-care academic centres in the USA.
Population: Women undergoing conventional laparoscopic or robot-assisted laparoscopic myomectomy.
Methods: All participants received the same 10-unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline).
Main Outcome Measures: The primary study outcome was estimated blood loss; the study was powered to detect a 100-ml difference.
Results: A total of 152 women were randomised; 76 patients in each group. Baseline demographics were similar between groups. The primary outcome of intraoperative blood loss was not significantly different, as measured by three parameters: surgeon estimate (mean estimated blood loss 178 ± 265 ml and 198 ± 232 ml, dilute and concentrated groups respectively, P = 0.65), suction canister-calculated blood loss, or change in haematocrit levels. There were no vasopressin-related adverse events.
Conclusion: Both dilute and concentrated vasopressin solutions that use the same drug dosing demonstrate comparable safety and tolerability when administered for minimally invasive myomectomy; however, higher volume administration of vasopressin does not reduce blood loss.
Tweetable Abstract: This randomised trial failed to show benefit of high-volume dilute vasopression.
(© 2016 Royal College of Obstetricians and Gynaecologists.)
Databáze: MEDLINE
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