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2015 ; 18
(4
): 543-54
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Pharmacologic agents for acute hemodynamic instability: recent advances in the
management of perioperative shock- a systematic review
#MMPMID26440241
Morozowich ST
; Ramakrishna H
Ann Card Anaesth
2015[Oct]; 18
(4
): 543-54
PMID26440241
show ga
Despite the growing body of evidence evaluating the efficacy of vasoactive agents
in the management of hemodynamic instability and circulatory shock, it appears no
agent is superior. This is becoming increasingly accepted as current guidelines
are moving away from detailed algorithms for the management of shock, and instead
succinctly state that vasoactive agents should be individualized and guided by
invasive hemodynamic monitoring. This extends to the perioperative period, where
vasoactive agent selection and use may still be left to the discretion of the
treating physician with a goal-directed approach, consisting of close hemodynamic
monitoring and administration of the lowest effective dose to achieve the
hemodynamic goals. Successful therapy depends on the ability to rapidly diagnose
the etiology of circulatory shock and thoroughly understand its pathophysiology
as well as the pharmacology of vasoactive agents. This review focuses on the
physiology and resuscitation goals in perioperative shock, as well as the
pharmacology and recent advances in vasoactive agent use in its management.