Treatment of Endotoxic Shock With Isoprenaline

Toit, H. J. Du; Plessis, J. M. E. Du; Dommisse, J; Rorke, M. J.; Theron, M.; Villiers, V. P. De

doi:10.1016/s0140-6736(66)92425-1

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…7., 1966). For this purpose either the alpha-adrenergic antagonist phenoxybenzamine or the quicker-acting beta-adrenergic receptor stimulator isoprenaline (du Toit, du Plessis, Dommisse, Rorke, Theron, and de Villiers, 1966) or orciprenaline, which is recommended by Shanks, Brick, Hutchison, and Roddie (1967) as being more easily obtainable, may be given. When using any of these drugs appropriate infusions should be administered to expand the blood volume to match the increased vascular bed.…”

Section: Necrosis Of Bowel-mckinnell and Kearneymentioning

confidence: 99%

Haemorrhagic necrosis of the intestine.

McKinnell¹,

Kearney²

1967

BMJ

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Section: Necrosis Of Bowel-mckinnell and Kearneymentioning

confidence: 99%

Haemorrhagic necrosis of the intestine.

McKinnell¹,

Kearney²

1967

BMJ

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“…Hg and the metabolic acidosis is corrected, the blood-pressure may not rise and vasopressors may remain ineffective. Digitalis sometimes improves myocardial function, but the inotropic action of isoprenaline infusions (2-5 mg. per litre) dramatically raises the bloodpressure, lowers the C.V.P., and increases the urine output (Duff, Malave, Peretz, Scott, and McLean, 1965;McLean, Duff, Scott, and Peretz, 1965;du Toit, du Plessis, Dommisse, Rorke, Theron, and de Villiers, 1966;Brooks, 1967b).…”

Section: Classification Of Septic Shockmentioning

confidence: 99%

The mechanism of shock

Brooks¹

1967

Journal of British Surgery

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441have had hypophysectomy and who require further surgery can excrete increased amounts of endogenous adrenal steroids. In paraplegic subjects the adrenal response to injury in the paralysed segments is delayed in onset and reduced in extent (Osborn, Schoenberg, Murphy, Erdman, and Young, 1962), but after operations under full spinal anaesthesia the response is only delayed a little and the intensity is unaffected (Mattingly and Tyler, 1965).The pattern of urinary excretion of the individual metabolites of adrenal androgens and gluco-corticoids is different after surgical operation compared to ACTH stimulation in the same patients. Surgical operation only stimulates the release of cortisol and its metabolites, whereas ACTH stimulates all aspects of adrenocortical production (Johnston, 1964).These observations support the view that a humoral agent from the injured part may act as an initiator. Some of the many substances liberated in damaged tissues, such as histamine and 5-hydroxytryptamine, can stimulate adrenal activity directly. Other changes, such as a reduction in blood-volume or extracellular space, and changes in concentration of sodium and potassium, are important in antidiuretic hormone and aldosterone release.One result of the basic studies which have been reviewed here has been to increase greatly the understanding of the events taking place in every surgical patient. Surgery has undoubtedly become safer as a consequence because departure from normal can be appreciated and logical steps taken to correct such variations.Sir Walter Langdon Browne in 1931 likened the endocrine system to an orchestra. This analogy still holds and gains in significance as a result of recent studies. Just as the individual members of an orchestra respond quickly to the conductor's signal with united purpose towards a single goal, so the stimulus of injury elicits an immediate and full response from all the endocrine organs for the purpose of maintaining homeostasis and providing the optimum conditions for efficient and rapid repair.

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“…Digitalis preparations are of value particularly for arrhythmias or congestive failure and are given in the form of digoxin 0-5 mg intravenously followed by 0-25 mg 6-hourly until the patient is fully digitalized (Wilson, 1965;du Toit et al, 1966;Shires & Carrico, 1966). If, in spite of digitalization, there is evidence of severe impairment of organ perfusion, e.g.…”

mentioning

confidence: 99%

“…If, in spite of digitalization, there is evidence of severe impairment of organ perfusion, e.g. severe oliguria, lethargy and extreme hypoventilation, drugs with positive inotropic action should be used and we have found isoprenaline particularly useful (du Toit et al, 1966). There is a risk of producing cardiac arrest and therefore all patients on isoprenaline therapy should be monitored cardiographically for signs of ischaemia resulting from tachycardia or arrhythmias.…”

mentioning

confidence: 99%

“…The drug is given as a I in 450,000 infusion commencing with a dose rate of 0-5-4-0 pg/min. Prior to the infusion the patient is transfused until the central venous pressure is at least 12 cm water and decrease in central venous pressure below 12 cm water after the isoprenaline has been started is matched with further fluid therapy until urinary excretion commences and/or a systolic blood pressure of 80 mmHg is maintained (du Toit et al, 1966).…”

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