Inotropic and Vasopressor Agents

Smith, L. T.; Oldershaw, Paul

doi:10.1093/bja/56.7.767

Cited by 12 publications

(2 citation statements)

References 24 publications

(33 reference statements)

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“…In practice the choice is a compromise between the desired effects and the undesired side-effects. There are many drugs which can and have been used to change inotropy and adrenergy; they are well reviewed elsewhere (6). T h e authors' current therapeutic preferences are outlined below.…”

Section: T H E O R E T I C a L Cvs I N T E R V E N T I O N Smentioning

confidence: 99%

Therapeutic Progress—review Xxxv: Therapeutic Progress in Intensive Care—rational Use of Vasoactive and Inotropic Drugs in the Intensive Care Unit

Clapham

Hopkinson

1989

J Clin Pharm Ther

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Summary Vasoactive (vasodilating and vasoconstricting) and inotropic drugs are widely used in intensive therapy. Major progress in their use in recent years has been due to a greater understanding of the physiological derangements of the critically ill. This progress is the consequence of improved standards of haemodynamic monitoring in the intensive therapy unit (ITU). In addition the introduction of accurate and reliable syringe pumps, to administer small volumes of fluid accurately, has enabled the easy use of drugs to manipulate physiological parameters. An understanding of the basic anatomy and physiology of the cardiovascular system (CVS) is essential to an understanding of the methods used for monitoring and measurement (1). Logical therapeutic interventions follow from consideration of these measured and derived parameters.

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Section: T H E O R E T I C a L Cvs I N T E R V E N T I O N Smentioning

confidence: 99%

Therapeutic Progress—review Xxxv: Therapeutic Progress in Intensive Care—rational Use of Vasoactive and Inotropic Drugs in the Intensive Care Unit

Clapham

Hopkinson

1989

J Clin Pharm Ther

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“…Many inotropic agents, such as ephedrine, dopamine, and dobutamine 1 , exert dose-dependent, positive inotropic effects and are commonly used during surgery under general anesthesia 2 . Most of these agents stimulate beta receptors, leading to protein kinase A activation.…”

Section: Introductionmentioning

confidence: 99%

PI3K/Akt pathway mediates the positive inotropic effects of insulin in Langendorff-perfused rat hearts

Nakadate

Kawakami

Sato

et al. 2022

Sci Rep

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Insulin exerts positive inotropic effects on cardiac muscle; however, the relationship between cardiac contractility and phosphoinositol-3-kinase/Akt (PI3K/Akt) activation remains unclear. We hypothesized that the positive inotropic effects of insulin are dose-dependent and mediated via the PI3K/Akt pathway in isolated normal rat hearts. The Institutional Animal Investigation Committee approved the use of hearts excised from rats under pentobarbital anesthesia. The hearts were perfused at a constant pressure using the Langendorff technique. After stabilization (baseline), the hearts were randomly divided into the following four insulin (Ins) groups: 1) Ins0 (0 IU/L), 2) Ins0.5 (0.5 IU/L), 3) Ins5 (5 IU/L), and 4) Ins50 (50 IU/L) (n = 8 in each group). To clarify the role of the PI3K/Akt pathway in insulin-dependent inotropic effects, we also treated the insulin groups with the PI3K inhibitor wortmannin (InsW): 5) InsW0 (0 IU/L), 6) InsW0.5 (0.5 IU/L), 7) InsW5 (5 IU/L), and 8) InsW50 (50 IU/L). Hearts were perfused with Krebs–Henseleit buffer solution with or without wortmannin for 10 min, followed by 20 min perfusion with the solution containing each concentration of insulin. The data were recorded as the maximum left ventricular derivative of pressure development (LV dP/dt max). Myocardial p-Akt levels were measured at 3 min, 5 min, and at the end of the perfusion. In the Ins groups, LV dP/dt max in Ins5 and Ins50 increased by 14% and 48%, respectively, 3 min after insulin perfusion compared with the baseline. Tachyphylaxis was observed after 10 min in the Ins5 and Ins50 treatment groups. Wortmannin partially inhibited the positive inotropic effect of insulin; although insulin enhanced p-Akt levels at all time points compared with the control group, this increase was suppressed in the presence of wortmannin. The positive inotropic effect of insulin is dose-dependent and consistent with Akt activation. This effect mediated by high doses of insulin on cardiac tissue was temporary and caused tachyphylaxis, potentially triggered by Akt overactivation, which leads beta 1 deactivation.

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Why, When and How I Use Norepinephrine in the Treatment of Septic Shock

Martin¹

1999

Yearbook of Intensive Care and Emergency Medicine

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Inotropic and Vasopressor Agents

Abstract: FIG. 1. Transition from the resting (digffolic) to the active (systolic) sate of cardiac myofibrila. Ashiftinthe orientation of the cross-bridges is associated with a longitudinal movement of the thin filament

Cited by 12 publications

References 24 publications

Therapeutic Progress—review Xxxv: Therapeutic Progress in Intensive Care—rational Use of Vasoactive and Inotropic Drugs in the Intensive Care Unit

Therapeutic Progress—review Xxxv: Therapeutic Progress in Intensive Care—rational Use of Vasoactive and Inotropic Drugs in the Intensive Care Unit

PI3K/Akt pathway mediates the positive inotropic effects of insulin in Langendorff-perfused rat hearts

Why, When and How I Use Norepinephrine in the Treatment of Septic Shock

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