Effects Of Vasoactive Drugs Research Articles

Effect of vasoactive drugs used for management of hypotension during pregnancy on uterine hemodynamic parameters: A systematic review and meta-analysis of preclinical and clinical studies

Effect of vasoactive drugs used for management of hypotension during pregnancy on uterine hemodynamic parameters: A systematic review and meta-analysis of preclinical and clinical studies

Adjusted pulse pressure associated with weaning from venoarterial extracorporeal membrane oxygenator in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract Funding Acknowledgements Type of funding sources: None. Background Limited data are available on predictors for weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Thus, we aimed to identify predictive ability for VA-ECMO weaning success and prognostic implications of serial pulse pressure (PP) and adjusted PP by vasoactive inotropic score (VIS) in AMI patients with CS who underwent VA-ECMO. Method A total of 213 patients with AMI complicated by CS who received VA-ECMO were enrolled between January 2010 and August 2021 from AMI-ECMO registry. Serial PP and VIS were measured at immediate, 12 hours, 24 hours, and 48 hours after VA-ECMO insertion. Adjusted PP by VIS was defined as PP/√VIS. The primary outcome was successful VA-ECMO weaning. The probability for VA-ECMO weaning success was assessed using the receiver-operating-characteristic (ROC) curve analysis. Results Successful weaning from VA-ECMO were observed in 151 patients (70.9%). PP and adjusted PP by VIS immediate after VA-ECMO insertion did not differ between successful and failed weaning groups. However, patients with successful weaning of VA-ECMO had a significantly higher serial PP and adjusted PP by VIS at 12, 24, and 48 hours after VA-ECMO insertion than those with failed weaning. In ROC analysis, 12 hours’ after adjusted PP by VIS showed significantly better discriminative function for VA-ECMO weaning success compared with PP alone (Area under the curve, adjusted PP by VIS vs. PP, 0.800 vs. 0.670, p=0.001). Patients with low adjusted PP by VIS at 12 hours (≤7) was associated with a higher in-hospital mortality (80.2% vs. 55.6%, p<0.001) and 6-month follow-up mortality (hazard ratio 2.41, 95% confidence interval 1.49-3.90, p<0.001) than those with high adjusted PP by VIS at 12 hours (>7). Conclusion Adjusted PP by VIS at 12 hours can predict successful weaning from VA-ECMO better than PP alone in CS patients complicating AMI who underwent VA-ECMO. These findings suggest that early PP after ECMO initiation can mean cardiac recovery, and its clinical significance may be enhanced when the effects of vasoactive drugs are adjusted.

Effects of vasoactive drugs on hepatic and intestinal circulation and intestinal barrier in patients with septic shock

In this study, 60 patients with septic shock were selected over the course of 1 year, and the effects of dopamine and norepinephrine combined with dobutamine on hepatic and intestinal...

Influence of Vasoactive Infusions on Body Temperature During Off Pump Coronary Artery Bypass Grafting

Abstract Introduction Unintentional hypothermia in patients undergoing off pump coronary artery bypass grafting (OPCABG) under general anesthesia (GA) is a known complication. The wide sternotomy wound as well as low ambient operating room temperature further promotes heat loss. The changes in temperature could further be affected by the use of various vasoactive drugs by affecting the thermoregulatory response. This study is aimed to detect the temperature changes and the influence of vasoactive infusions on the temperature in the patients undergoing OPCABG under GA. Aims The main purpose of this article is to assess the core and skin temperature changes during OPCABG surgery and to assess the effect of vasoactive infusion used intraoperatively on the core temperature Settings and Design Single center, nonrandomized, open label, observational study. Methods and material After informed consent and ethical clearance from institutional review board, 151 adult patients undergoing elective OPCABG surgeries under GA were included in the study. A common anesthetic protocol and warming strategy was used in all patients. The core temperature measured with a nasopharyngeal probe and the skin temperature measured at the palmar surface of the right index finger were recorded at induction, at 30 minutes intervals thereafter, and at end surgery. The demographic variables and the duration of surgery were also recorded. The type and dose of vasoactive agents used intraoperatively were also recorded. The study population was divided post hoc into groups and subgroups for further analysis. Results All the patients showed a decrease in core temperature at end surgery. The temperature changes showed an initial exponential decrease in the first hour followed by a gradual decrease subsequently. The peripheral temperature showed a gradual increase from induction to end surgery. The temperature gradients showed a linear decrease with the core temperature and peripheral skin temperature reaching equilibrium at end surgery. The study population was divided into four groups depending on the type of vasoactive drugs received intraoperatively: vasoconstrictor (V), vasodilator (D), mixed vasoconstrictor and vasodilator (M), and no vasoactive drugs (N) group. The patients in the vasoconstrictor group had a higher core temperature at end surgery when compared with vasodilator group. Conclusions OPCABG under GA results in decrease in core temperature. The decrease in temperature is exponential in the initial 1 hour followed by a more gradual decrease. The temperature changes are possibly affected by the vasoactive drugs used intraoperatively. The effect of vasoactive drugs on core temperature is higher when used during the initial exponential decrease in temperature. However, further adequately powered randomized controlled trials may be required to establish these findings.

Effects of vasoactive drugs on crystalloid fluid kinetics in septic sheep

PurposeCrystalloid fluid and vasoactive drugs are used in the early treatment of sepsis. The purpose of the present study was to examine how these drugs alter plasma volume expansion, peripheral edema, and urinary excretion.MethodsTwenty-five anesthetized sheep were made septic by cecal puncture and a short infusion of lipopolysaccharide. After 50 min, a slow infusion of isotonic saline was initiated: the saline either contained no drug, norepinephrine (1 μg/kg/min), phenylephrine (3 μg/kg/min), dopamine (50 μg/kg/min), or esmolol (50 μg/kg/min). Ten min later, 20 mL/kg Ringer´s lactate solution was given over 30 min. Central hemodynamics, acid-base balance, and the urinary excretion were monitored. Frequent measurements of the blood hemoglobin concentration were used as input in a kinetic analysis, using a mixed effects modeling software.ResultsThe fluid kinetic analysis showed slow distribution and elimination of Ringer´s lactate, although phenylephrine and dopamine accelerated the distribution. Once distributed, the fluid remained in the peripheral tissues and did not equilibrate adequately with the plasma. Overall, stimulation of adrenergic alpha1-receptors accelerated, while beta1-receptors retarded, the distribution and elimination of fluid. A pharmacodynamic Emax model showed that Ringer´s lactate increased stroke volume by 13 ml/beat. Alpha1-receptors, but not beta1-receptors, further increased stroke volume, while both raised the mean arterial pressure. Modulation of the beta1-receptors limited the acidosis.ConclusionsStimulation of adrenergic alpha1-receptors with vasoactive drugs accelerated, while beta1-receptors retarded, the distribution and elimination of fluid. The tendency for peripheral accumulation of fluid was pronounced, in particular when phenylephrine was given.

The effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials

PurposeInotropes and vasopressors are cornerstone of therapy in septic shock, but search for the best agent is ongoing. We aimed to determine which vasoactive drug is associated with the best survival. Materials and methodsPubMed, BioMedCentral, Embase, and the Cochrane Central Register were searched. Randomized trials performed in septic patients with at least 1 group allocated to an inotrope/vasopressor were included. Network meta-analysis with a frequentist approach was performed. ResultsThe 33 included studies randomized 3470 patients to 16 different comparators. As compared with placebo, levosimendan (odds ratio [OR], 0.17, 95%; confidence interval [CI], 0.05-0.60), dobutamine (OR, 0.30; 95% CI, 0.09-0.99), epinephrine (OR, 0.35; 95% CI, 0.13-0.96), vasopressin (OR, 0.37; 95% CI, 0.16-0.89), and norepinephrine plus dobutamine (OR, 0.4; 95% CI, 0.11-0.96) were significantly associated with survival. Norepinephrine improved survival compared with dopamine (OR, 0.81; 95% CI, 0.66-1.00). Rank analysis showed that levosimendan had the highest probability of being the best treatment. ConclusionsAmong several regimens for pharmacological cardiovascular support in septic patients, regimens based on inodilators have the highest probability of improve survival.

Mechanical Circulatory Support for Advanced Heart Failure

Patients with end-stage heart failure or cardiogenic shock experience unacceptably high mortality despite advances in treatment made over the past 50 years. The effects of vasoactive drugs used to manage cardiogenic shock may be limited, being highly dependent on “remaining” heart function. Mechanical circulatory support improves cardiac output independent of heart function. Intra-aortic balloon pumps (IABPs) and extracorporeal membrane oxygenation (ECMO) are the devices most commonly used in Korea. Despite frequent use, the utility of IABPs in acute myocardial patients remains controversial, whereas ECMO affords sufficient systemic perfusion pressure to reverse end-organ dysfunction. Both can only be used as acute treatments, thus as a bridge-to-recovery or a bridge-to-transplantation. Percutaneous left ventricular assist devices (LVADs) such as TandemHeart® and Impella are not in use in Korea. Implanted LVADs improve long-term outcomes and may also serve as destination therapies. In the present manuscript, we briefly review percutaneous and implantable devices currently used in Korea for the management of advanced heart failure. (Korean J Med 2015;88:142-149)

Effect of vasoactive drugs on the response of the baroreceptor and regulation of heart rate variability in patients with septic shock

We evaluated the action of vasoactive drugs on baroreceptor regulation and the interaction of this in regulation of heart rate variability (HRV) in patients with septic shock.

The effects of vasoactive drugs on pulse pressure and stroke volume variation in postoperative ventilated patients

IntroductionAlthough pulse pressure variation (PPV) and stroke volume variation (SVV) during mechanical ventilation have been shown to predict preload responsiveness, the effect of vasoactive therapy on PPV and SVV is unknown. MethodsPulse pressure variation and SVV were measured continuously in 15 cardiac surgery patients for the first 4 postoperative hours. Pulse pressure variation was directly measured from the arterial pressure waveform, and both PPV and SVV were also calculated by LiDCO Plus (LiDCO Ltd, Cambridge, United Kingdom) before and after volume challenges or changes in vasoactive drug infusions done to sustain cardiovascular stability. ResultsSeventy-one paired events were studied (38 vasodilator, 10 vasoconstrictor, 14 inotropes, and 9 volume challenges). The difference between the measured and LiDCO-calculated PPV was 1% ± 7% (1.96 SD, 95% confidence interval, r2 = 0.8). Volume challenge decreased both PPV and SVV (15% to 10%, P < .05 and 13% to 9%, P = .09, respectively). Vasodilator therapy increased PPV and SVV (13% to 17% and 9% to 15%, respectively, P < .001), whereas increasing inotropes or vasoconstrictors did not alter PPV or SVV. The PPV/SVV ratio was unaffected by treatments. ConclusionVolume loading decreased PPV and SVV; and vasodilators increased both, consistent with their known cardiovascular effects. Thus, SVV and PPV can be used to drive fluid resuscitation algorithms in the setting of changing vasoactive drug therapy.

The Effects of Vasoactive Drugs on Intestinal Functional Capillary Density in Endotoxemic Rats: Intravital Video-Microscopy Analysis

The use of vasoactive drugs to restore arterial blood pressure in patients with septic shock remains a cornerstone of intensive care medicine. However, vasopressors can accentuate the hypoperfusion of the gut during septic shock, allowing bacterial translocation and endotoxemia. In this study, we compared the effects of different vasoactive drugs on intestinal microcirculation and tissue oxygenation, independent of the effects of fluid therapy, in a rat model of endotoxemic shock. Pentobarbital-anesthetized Wistar Kyoto rats were submitted to endotoxemic shock induced by Escherichia coli lipopolysaccharide (2 mg/kg IV). Arterial blood pressure was normalized by a continuous infusion of different vasoactive drugs, including epinephrine, norepinephrine, phenylephrine, dopamine, dobutamine, or a combination of dobutamine and norepinephrine. The functional capillary density (FCD) of the muscular layer of the small intestine was evaluated by intravital video-microscopy. Mesenteric venous blood gases and lactate concentrations were also analyzed. FCD decreased by approximately 25% to 60% after the IV infusion of epinephrine, norepinephrine, and phenylephrine. Administration of dopamine, dobutamine, and the combination of dobutamine and norepinephrine did not induce significant alterations in gut FCD. In addition, the mesenteric venous lactate concentration increased in the presence of phenylephrine and showed a tendency to increase after the administration of epinephrine and norepinephrine, whereas there was no observable increase after the administration of dopamine, dobutamine, and the combination of dobutamine with norepinephrine. This study confirms dissociation of the systemic hemodynamic and microvascular alterations in an experimental model of septic shock. Moreover, the results indicate that the use of dopamine, dobutamine, and dobutamine in combination with norepinephrine yields a protective effect on the microcirculation of the intestinal muscular layer in endotoxemic rats.

The Effects of Hypocapnia and the Cerebral Autoregulatory Response on Cerebrovascular Resistance and Apparent Zero Flow Pressure During Isoflurane Anesthesia

Simultaneous recordings of arterial blood pressure (ABP) and middle cerebral artery blood velocity can be used to calculate the apparent zero flow pressure (aZFP). The inverse of the slope of the pressure-velocity relationship is known as resistance area product (RAP) and is an index of cerebrovascular resistance. There is little information available regarding the effects of vasoactive drugs, arterial carbon dioxide (Paco(2)), and impaired cerebral autoregulation on aZFP and RAP during general anesthesia. During isoflurane anesthesia, we investigated the effects of hypocapnia and the effects of a phenylephrine infusion, on aZFP and RAP. Radial ABP and transcranial Doppler middle cerebral artery blood velocity signals were recorded in 11 adults undergoing isoflurane anesthesia. A phenylephrine infusion was used to increase ABP and ventilation was adjusted to control Paco(2). Cerebral hemodynamic variables were compared at two levels of mean ABP (approximately 80 and 100 mm Hg) and at two levels of Paco(2): normocapnia (Paco(2) 38-43 mm Hg) and hypocapnia (Paco(2) 27-34 mm Hg). Two aZFP analysis methods were compared: one based on linear regression and one based on Fourier analysis of the waveforms. At the lower ABP, aZFP was 23 +/- 11 mm Hg and 30 +/- 13 mm Hg (mean +/- sd) with normocapnia and hypocapnia, respectively (P < 0.001) and RAP was 0.76 +/- 0.97 mm Hg x s x cm(-1) and 1.16 +/- 0.16 mm Hg x s x cm(-1) with normocapnia and hypocapnia, respectively (P < 0.001). Similar effects of hypocapnia were seen at the higher ABP. With normocapnia, isoflurane impaired cerebral autoregulation and aZFP did not change with the increase in ABP. With hypocapnia, cerebral autoregulation was not significantly impaired and increasing ABP was associated with increased aZFP (from 30 +/- 13 to 35 +/- 13 mm Hg, P < 0.01) and increased RAP (from 1.16 +/- 0.16 to 1.52 +/- 0.20 mm Hg x s x cm(-1), P < 0.001). Calculation of the relative contributions of aZFP and RAP to the cerebral hemodynamic responses indicated that changes in RAP appeared to have a greater influence than changes in aZFP. The mean difference between the two methods of determining aZFP (Fourier-regression) was 0.5 +/- 3.6 mm Hg (mean +/- 2sd). During isoflurane anesthesia, two interventions that increase cerebral arteriolar tone, hypocapnia and the autoregulatory response to increasing ABP, were associated with increased RAP and increased aZFP. The effect of changes in RAP appeared to be quantitatively greater than the effects of changes in aZFP. These results imply that arteriolar tone influences cerebral blood flow by controlling both resistance and effective downstream pressure.

Assessment of the Vascular Effects of PC6 (Neiguan) Using the Second Derivative of the Finger Photoplethysmogram in Healthy and Hypertensive Subjects

Indices obtained from the second derivative of the digital volume pulse waveform have been proposed to characterize vascular aging, arterial rigidity, and the effects of vasoactive drugs. The purpose of this study was to assess the effects of manual needling of PC6 on SD(DVP) indices in healthy and untreated hypertensive subjects. AI, B:A, and D:A indices, based on the height of the wave components of SD(DVP), in 40 healthy subjects and 25 untreated hypertensive subjects were compared. DVP was obtained by measuring infrared light transmission through the finger. For each subject, 20-min-long DVP registration was obtained. PC6 was stimulated unilaterally by manual needling for 5 min (1-6 min). In each subject, pre-acupuncture DVP indices were compared to those of during acupuncture (1 vs. 4 min) and post-acupuncture (1 vs. 18 min). In healthy subjects, AI was significantly improved when comparing the pre- to the post-acupuncture values. In hypertensive subjects, the SD(DVP) indices improved significantly as follows: the AI index when the value of pre-acupuncture comparing to that of during acupuncture and post-acupuncture values; B:A and D:A indices when the pre-comparing to post-acupuncture values. There were significant differences between healthy and hypertensive subjects in AI, B:A, and D:A at baseline and in B:A in the during acupuncture period; there were no significant differences at post-acupuncture. These results indicate that manual needling of PC6 produced acute effects on vascular pathophysiology. Moreover, PC6 needling produced changes in SD(DVP) indices related to both large artery stiffness and the reflected wave originating in small arteries.

What effect of vasoactive drugs on passive leg raising response in critically ill patients?

Passive leg raising (PLR) mimics the hemodynamic effects of rapid fluid loading (FL) by shifting venous blood from the legs towards the intrathoracic compartment and by increasing right and left ventricular preloads.

Systemic and regional effects of vasoactive drugs

Systemic and regional effects of vasoactive drugs

The effects of vasoactive drugs on hepatic blood flow changes induced by CO2 laparoscopy: an animal study.

Laparoscopic surgery is associated with systemic and splanchnic hemodynamic alterations. Recent data suggest that small-dose dobutamine may attenuate the reduction in splanchnic blood flow associated with increments in intraabdominal pressure. We conducted this study to analyze the effects of dopamine and dobutamine on the hepatic circulation in this setting. Twenty-one pigs were anesthetized and mechanically ventilated. A flow-directed pulmonary artery and carotid artery catheters were inserted. Perivascular flow probes were placed around the main hepatic artery and the portal vein. CO2 was insufflated into the peritoneal cavity to reach an intraabdominal pressure of 15 mm Hg. After 60 min, animals received dopamine (5 microg x kg(-1) x min(-1); n = 8), dobutamine (5 microg x kg(-1) x min(-1); n = 8), or saline (n = 5) for 30 min. Pneumoperitoneum induced significant increases in heart rate, mean arterial pressure, and systemic vascular resistance, with decreases in cardiac output and hepatic artery and portal vein blood flows. Dobutamine infusion, in contrast to dopamine, corrected, at least in part, cardiac output, systemic vascular resistance, and hepatic artery blood flow alterations, but neither drug restored total hepatic blood flow. Hepatic blood flow decreases during laparoscopic surgery. A small-dose infusion of neither dobutamine nor dopamine corrects the total hepatic blood flow impairment, but the former is able to restore the hepatic arterial blood supply in an animal model mimicking this condition.

Selective Effects of Subarachnoid Hemorrhage on Cerebral Vascular Responses to 4-Aminopyridine in Rats

We postulated that some abnormalities in cerebrovascular function after subarachnoid hemorrhage (SAH) may involve underlying alterations in K(+) channel function. Thus, using pharmacological inhibitors, we assessed the influence of SAH on function of 2 types of K(+) channel in regulation of basilar artery diameter in vivo and membrane potential (E(m)) in vitro. Rats were injected with saline (control) or autologous blood (SAH) into the cisterna magna. Two days later, effects of vasoactive drugs on the basilar artery were examined with a cranial window preparation. Vascular responses to 4-aminopyridine (4-AP), 3-aminopyridine (3-AP), tetraethylammonium (TEA), serotonin, acetylcholine, and adenosine were compared in control and SAH rats. Additional studies using intracellular microelectrodes evaluated the effects of 4-AP and serotonin on E(m) of basilar arteries isolated from control and SAH rats. Baseline artery diameter was 236+/-5 micrometer in control rats and 220+/-7 micrometer in SAH rats (P:<0. 05). 4-AP, but not 3-AP, constricted the basilar artery in control rats, and responses to 4-AP were reduced in SAH rats. Constrictor responses to TEA or serotonin were unaffected by SAH. Vasodilator responses to acetylcholine were impaired in SAH rats, whereas responses to adenosine were not different. Resting E(m) was -81+/-3 mV in control arteries and -79+/-3 mV in SAH arteries. Both 4-AP and serotonin depolarized the basilar artery, but only 4-AP-induced depolarization was impaired in SAH arteries. These data suggest that 4-AP induces cerebral vasoconstriction in vivo through smooth muscle depolarization due to inhibition of voltage-dependent K(+) channels. Furthermore, function of these K(+) channels may be selectively reduced in the basilar artery after SAH and thus could contribute to cerebral vascular dysfunction.

Effects of vasoactive drugs on arterial compliance in cirrhoticpatients

Effects of vasoactive drugs on arterial compliance in cirrhoticpatients

Impaired cerebral vasodilator responses to NO and PDE V inhibition after subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) is associated with impaired nitric oxide (NO)-mediated cerebral vasodilatation. We tested the hypothesis that SAH causes alterations in the production of, hydrolysis of, or responsiveness to cGMP in the rat basilar artery in vivo. Rats were injected with saline or autologous blood into the cisterna magna. Two days later, effects of vasoactive drugs on basilar artery diameter were examined using a cranial window preparation. Vasodilator responses to ACh, sodium nitroprusside (SNP), and low concentrations (</=10(-5) M) of zaprinast, an inhibitor of phosphodiesterase V (PDE V), were impaired in SAH rats (P < 0.05). In contrast, vasodilator responses to adenosine and 8-BrcGMP were similar in control and SAH rats. Vasoconstrictor responses to 1H-[1,2,4]oxadiazolo[4,3,-a]quinoxalin-1-one, an inhibitor of soluble guanylate cyclase, were unaffected by SAH. In the presence of zaprinast (10(-5)-10(-4) M), responses to ACh and SNP were equivalent in control and SAH rats. Thus an increased rate of cGMP hydrolysis by PDE V may be a major factor contributing to the impairment of NO-mediated cerebral vasodilatation after SAH.

Effects of vasoactive drugs on gastric intramucosal pH.

To review current knowledge about the effects of vasoactive agents on gastric intramucosal pH (pHi). All studies involving pHi and vasoactive agents were retrieved from a computerized MEDLINE search from 1980 to 1997. We also reviewed the reference lists of all available review articles and primary studies to identify references not found in the computerized searches. Clinical and experimental studies using dopamine, dopexamine, dobutamine, norepinephrine, epinephrine, nitric oxide, N-acetylcysteine, prostaglandins, or pentoxifylline were considered if splanchnic perfusion and/or pHi measurements were utilized. From the selected studies, information was obtained regarding patient population, dosing regimen, duration of study, and effects on splanchnic blood flow (SBF), splanchnic oxygenation, and pHi. Although dopaminergic effects increase SBF, dopamine does not generally increase pHi. Data on the effects of dopexamine on pHi are scarce and inconsistent. Dobutamine can significantly increase SBF and usually increases pHi. In septic patients, norepinephrine seems to increase pHi. Epinephrine may have detrimental effects on gastric perfusion. Prostacyclin seems to increase pHi but data are limited. Insufficient evidence exists to support the beneficial effects of nitric oxide donors or blockers, pentoxifylline, or N-acetylcysteine on pHi. Overall, the effects of vasoactive agents on pHi are unpredictable. Among the catecholamines, dopamine is the least likely, and dobutamine the most likely, to increase pHi.

Positional changes and drug interventions in acute respiratory failure.

Acute respiratory failure is often a life-threatening condition that determines the outcome of acutely ill patients. This review discusses the physiological basis and results of two complementary approaches for the management of such patients: positional changes and drug interventions. In unilateral pulmonary disease locating the healthy lung in a dependent position may improve gas exchange; in bilateral involvement, as occurs in the acute respiratory distress syndrome (ARDS), both the theoretical principles and the observed benefits fully support the use of the prone position. The effect of vasoactive drugs on pulmonary circulation and gas exchange is also reviewed. Selective vasodilators, such as inhaled nitric oxide and prostacycline-12, may provide a useful alternative in ARDS.