• Normal or decreased CVP/PAWP
• Increased CO/CI
• Decreased SVR
• Decreased BP
• Sepsis/septic shock
• Severe anemia
• Spinal shock
• Anaphylactic shock
• End-stage cirrhosis
• Improved tissue perfusion
• Expected Response
• increased SVR
• increased CVP/PAWP
• increased BP
• Vasopressors
• dopamine
• epinephrine
• norepinephrine
• phenylephrine
• Caution: many patients with decreased afterload may also have hypovolemia & preload may need to be increased also.
• Alpha Receptors
• stimulation of alpha I receptors produces vasoconstriction
• Beta receptors
• stimulation of beta I receptors increases the inotropic and chrontotropic state of the heart
• stimulation of beta II receptors produces vascular smooth muscle relaxation
• Always infuse through a central line
• Extravasation of drug into tissues may cause severe tissue inflammation and/or necrosis
• Start at lowest dose, titrate to effect
• Wait 5-10 minutes between dose adjustments
• Be patient, time stands still
• Strong alpha & beta stimulant, effect varies with dose
• Stimulates dopaminergic receptors
• Vasopressor effect is mild at low doses and increases as dose is increased
• Dose up to 20 mcg/kg/min for vasopressor effect
• Titrate to effect
• Strong alpha stimulant, milder beta stimulant
• Dose: start at 1 mcg/min
• Titrate to effect
• Strong alpha stimulant
• Mild beta stimulant
• Dose: 1 mcg/min to 20 mcg/min
• Titrate to effect
• Stronger alpha stimulant than beta
• Dose: start at 15mcg/min
• Titrate to effect
• Vasopressors work by stimulating alpha receptors (sympathetic nervous system)
• Normal vasopressor response is a rapid rise in BP
• Failure of vasopressor to raise BP is an indication of severity of condition
• Consider effects of drugs particularly when doses are maximized
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Date last modified: January 7, 2013.
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