{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T18:10:03Z","timestamp":1771956603166,"version":"3.50.1"},"reference-count":10,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,9,9]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>A 34-year-old patient underwent a laparoscopic myomectomy, complicated by a profound episode of bradycardia and hypotension following intramyometrial infiltration of vasopressin (20\u2009IU), promptly corrected with intravenous ephedrine (6\u2009mg) and glycopyrrolate (200\u2009\u00b5g). At extubation, pink frothy fluid was noted in the endotracheal tube; she was visibly distressed, desaturated to 89% in air and was coughing up pink stained fluid. Acute pulmonary oedema secondary to vasopressin was suspected. A tight-fitting oxygen mask (100%) with positive end expiratory pressure was applied and intravenous furosemide (20\u2009mg) and diamorphine (4\u2009mg, 1\u2009mg increments) were administered to facilitate diuresis and oxygenation. Chest X-ray confirmed acute pulmonary oedema. Arterial blood gas demonstrated type 2 respiratory failure. Over 12 hours, the oxygen was weaned to 1\u2009L\/min. She demonstrated excellent diuresis. Troponin and brain-natriuretic peptide were elevated, but echocardiogram was normal. The cardiology diagnosis was vasopressin-induced coronary vasospasm, precipitating acute pulmonary oedema. She was discharged home on day 5.<\/jats:p>","DOI":"10.1136\/bcr-2019-231331","type":"journal-article","created":{"date-parts":[[2019,12,12]],"date-time":"2019-12-12T04:55:23Z","timestamp":1576126523000},"page":"e231331","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Risk of vasopressin use: a case of acute pulmonary oedema, post intramyometrial infiltration of vasopressin in laparoscopic myomectomy"],"prefix":"10.1136","volume":"12","author":[{"given":"Jennifer Frances","family":"Barcroft","sequence":"first","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asmaa","family":"Al-Kufaishi","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine","family":"Lowe","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Quinn","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,12,11]]},"reference":[{"key":"2025082707432468000_12.12.e231331.1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.83.6.2111"},{"key":"2025082707432468000_12.12.e231331.2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1002\/j.1552-4604.1998.tb04426.x","article-title":"Paradoxical hypotension and bradycardia after intravenous arginine vasopressin","volume":"38","author":"Kraft","year":"1998","journal-title":"J Clin Pharmacol"},{"key":"2025082707432468000_12.12.e231331.3","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318187e795"},{"key":"2025082707432468000_12.12.e231331.4","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31822cef10"},{"key":"2025082707432468000_12.12.e231331.5","doi-asserted-by":"crossref","first-page":"396","DOI":"10.4103\/1658-354X.136630","article-title":"Bradycardia and severe vasospasm caused by intramyometrial injection of vasopressin during myomectomy","volume":"8","author":"Butala","year":"2014","journal-title":"Saudi J Anaesth"},{"key":"2025082707432468000_12.12.e231331.6","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3109\/00016347009157513","article-title":"Ornithine-8-vasopressin, a new vasoconstrictor used for haemostasis during operation for genital prolapse","volume":"49","author":"Nielsen","year":"1970","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025082707432468000_12.12.e231331.7","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1111\/1471-0528.14179","article-title":"Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial","volume":"124","author":"Cohen","year":"2017","journal-title":"BJOG: Int J Obstet Gy"},{"key":"2025082707432468000_12.12.e231331.8","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1046\/j.1365-2508.1999.00246.x","article-title":"Adhesions after laparoscopic myomectomy: effect of the technique used","volume":"8","author":"Assaf","year":"1999","journal-title":"Gynecol Endosc"},{"key":"2025082707432468000_12.12.e231331.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2010.08.059"},{"key":"2025082707432468000_12.12.e231331.10","doi-asserted-by":"crossref","unstructured":"Kongnyuy EJ , Wiysonge CS . 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