Vasoplegia After Cardiovascular Procedures—Pathophysiology and Targeted Therapy

Shaefi, Shahzad; Mittel, Aaron; Klick, John; Evans, Adam S.; Ivascu, Natalia S.; Gutsche, Jacob T.; Augoustides, John

doi:10.1053/j.jvca.2017.10.032

Cited by 141 publications

(161 citation statements)

References 62 publications

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“…Currently hydroxocobalamin is 10x as expensive as MB and its use has been studied in case series only. It may be considered in patients with glucose‐6‐phosphatase dehydrogenase deficiency or in those with risk factors of serotonin syndrome …”

Section: Discussionmentioning

confidence: 99%

“…It may be considered in patients with glucose-6-phosphatase dehydrogenase deficiency or in those with risk factors of serotonin syndrome. 52 Use of MB or hydroxocobalamin as prophylaxis versus rescue therapy for vasoplegia is still debated and remains so in the absence of prospective trials on optimal timing and dosing of the drugs.…”

Section: Prescription Of Rasi (Aras and Ace Inhibitors) Is Common Andmentioning

confidence: 99%

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When the pressure drops: A case of vasoplegia during a structural heart intervention

Cox

Noveras

Harrell

et al. 2019

Cathet Cardio Intervent

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A 67‐year‐old male underwent general anesthesia for left atrial appendage occlusion. During the procedure, the patient developed catecholamine refractory hypotension requiring the administration of several vasopressin boluses to maintain adequate perfusion pressure. At the conclusion of the procedure, mild venous bleeding necessitated the administration of protamine. This led to a further decrease in the patient's blood pressure. Tamponade and continued volume loss were quickly ruled out leading to a diagnosis of vasoplegia syndrome (VS). The patient was appropriately treated with a vasopressin infusion with normalization of blood pressure and no significant morbidity or adverse outcome. With the use of general anesthesia during structural heart interventions on the rapid rise, we discuss the two common causes for vasoplegia along with evidence‐based treatments and possible prevention strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Prescription Of Rasi (Aras and Ace Inhibitors) Is Common Andmentioning

confidence: 99%

When the pressure drops: A case of vasoplegia during a structural heart intervention

Cox

Noveras

Harrell

et al. 2019

Cathet Cardio Intervent

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“…1;21 The first possibility is that patients on ACEI and ARBS may be at greater risk for vasoplegia in the setting of an exaggerated systemic inflammatory response, akin to what we typically observe in perioperative cardiothoracic and vascular practice. [4][5] A second possibility is that the severe alveolar endothelial damage from adult respiratory distress syndrome may disrupt the function of angiotensin-converting enzyme 1, interfering with the hydrolysis of angiotensin I to form angiotensin II. [1][2][3] The resulting deficiency of angiotensin II leads to loss of systemic vascular tone.…”

Section: Raas Inhibitors and Vasoplegic Shock In Covid -19mentioning

confidence: 99%

“…3 Furthermore, the consequences of this pharmacologic blockade of the RAAS in perioperative cardiothoracic and vascular practice has been well-recognized, leading to the emergence of rescue therapies for support of vascular tone. [4][5] The severe acute respiratory syndrome coronavirus-2 infects human cells such as alveolar endothelium in the lung by binding to the membrane receptor, angiotensin-converting enzyme 2 (ACE2). [1][2][3] Although the physiologic functions of ACE2 include counteracting the effects of RAAS activation, it also functions as a membrane receptor for the coronavirus.…”

Section: Introductionmentioning

confidence: 99%

The Renin-Angiotensin-Aldosterone System in Coronavirus Infection—Current Considerations During the Pandemic

Augoustides

2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…A síndrome vasoplégica (SV), também conhecida por choque vasodilatador ou distributivo, é caracterizada por hipoperfusão de órgão-alvo secundária à hipotensão arterial, acompanhada de DC normal ou alto, RVS baixa e aumento das necessidades de volume intravascular ou de vasopressores. 28,29 Ela não só é caracterizada por vasodilatação, mas, principalmente, pela perda da reatividade e tônus vascular basal. 29 Liu et al (2017) sugerem os seguintes componentes diagnósticos: hipotensão arterial grave (PAM < 50 mmHg) sem uma causa identificável e refratária à terapia tradicional com catecolaminas; IRVS baixo (< 1600 dyn·seg/cm 5 ·m 2 ); índice cardíaco normal ou alto (> 2,5 L/min/m 2 ); irresponsividade frente a expansão volêmica adequada e a terapia tradicional com catecolaminas.…”

Section: Síndrome Vasoplégicaunclassified

"How do i perform" in cardiac anesthesia crisis situations?

Brochado¹,

Medeiros²,

Penholati³

et al. 2018

Revista Médica De Minas Gerais

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The pathophysiology of the right ventricle, especially in the context of cardiac surgery, is crucial for proper perioperative management. Right heart failure significantly increases surgical morbidity and mortality, reason why early diagnosis and adequate therapy against this condition are mandatory. The vasoplegic syndrome is a frequent morbidity after cardiac surgery and, like right ventricular failure, is associated with an unfavorable outcome. It is characterized by low systemic vascular resistance and arterial hypotension in the presence of normal or supranormal cardiac function. In addition, it is linked to an intense systemic inflammatory response. This article deals with anatomophysiological aspects, diagnosis and treatment strategies for the aforementioned crisis situations.A compreensão da fisiopatologia do ventrículo direito, especialmente no contexto de cirurgia cardíaca, é fundamental para o adequado manejo perioperatório. A insuficiência ventricular direita aumenta significativamente a morbimortalidade cirúrgica, motivo pelo qual faz-se necessário o diagnóstico precoce e abordagem terapêutica específica desta entidade. A síndrome vasoplégica é uma morbidade frequente após cirurgia cardíaca e, assim como a falência do ventrículo direito, está associada à um desfecho desfavorável. É caracterizada por baixa resistência vascular sistêmica e hipotensão arterial na presença de função cardíaca normal ou supranormal. Adicionalmente, está vinculada a intensa resposta inflamatória sistêmica. Neste artigo serão abordados os aspectos anatomofisiológicos, diagnóstico e estratégias de tratamento das situações de crise supracitadas.Palavras-chave: Disfunção ventricular direita. Hipertensão pulmonar. Síndrome vasoplégica. Anestesia para cirurgia cardíaca. Situações de crise.

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Vasoplegia After Cardiovascular Procedures—Pathophysiology and Targeted Therapy

Cited by 141 publications

References 62 publications

When the pressure drops: A case of vasoplegia during a structural heart intervention

When the pressure drops: A case of vasoplegia during a structural heart intervention

The Renin-Angiotensin-Aldosterone System in Coronavirus Infection—Current Considerations During the Pandemic

"How do i perform" in cardiac anesthesia crisis situations?

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