Effects of epinephrine, norepinephrine, and phenylephrine on microcirculatory blood flow in the gastrointestinal tract in sepsis*

Abstract

Administration of the vasopressors phenylephrine, epinephrine, and norepinephrine failed to increase microcirculatory blood flow in most abdominal organs despite increased perfusion pressure and-in the case of epinephrine and norepinephrine-increased systemic blood flow. In fact, norepinephrine and epinephrine appeared to divert blood flow away from the mesenteric circulation and decrease microcirculatory blood flow in the jejunal mucosa and pancreas. Phenylephrine, on the other hand, appeared to increase blood pressure without affecting quantitative blood flow or distribution of blood flow.

Impact of hypoxic hepatitis on mortality in the intensive care unit

“…The principal response of the hepatic vascular bed to catecholamines is vasoconstriction [21,22]. Norepinephrine and epinephrine divert blood flow away from the mesenteric circulation and decrease microcirculatory blood flow in the gastrointestinal tract despite increased perfusion pressure and increased systemic blood flow in experimental sepsis [23]. These may be a consequence of impaired hepatic blood flow regulation and prolongation of vasopressor effects due to reduced hepatocyte metabolism [24].…”

Temporary Prosthetic Shunt to Permanent Aortic Prosthesis in a Patient with an Infected Thoracoabdominal Aneurysm to Shorten Ischemia Time~!2010-04-04~!2010-06-03~!2010-07-26~!

“…Postoperative hypotension in combination with high doses of catecholamines is a likely cause of the intestinal infarction in our case [9]. Postoperative hypotension was likely caused by the initial clamp ischemia and uncontrolled infection in the extensive aneurysm sac and the surgical trauma were possible contributory causes [10].…”

Anesthetic considerations in organ procurement surgery: a narrative review

“…31 Accordingly, some surgeons consider intraoperative administration of fluid as the preferred method to improve blood pressure in a hypotensive donor patient, with vasopressors being relatively contraindicated due to vasoconstriction and decreased blood flow to vital organs. [32][33][34] Nevertheless, the dangers to long-term organ function arising from hypotension-related organ hypoperfusion and reduced oxygen delivery may outweigh the risks associated with using vasopressors. A balanced plan to maintain adequate blood pressure thus incorporates the replacement of intravenous fluid deficits while judiciously using vasopressors to counteract the decrease in systemic vascular resistance that occurs in patients after brain death.…”