Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewArginine vasopressin in the treatment of vasodilatory septic shock.
Vasodilatory septic shock is characterized by profound vasodilation of the peripheral circulation, relative refractoriness to catecholamines and a relative deficiency of the posterior pituitary hormone, vasopressin. Arginine vasopressin is effective in restoring vascular tone in vasodilatory septic shock and may be associated with decreased mortality in less severe septic shock as well as improved mortality and decreased renal failure in septic shock patients at risk for renal failure.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewRole of arginine vasopressin in the setting of cardiopulmonary resuscitation.
Arginine vasopressin (AVP) constitutes an integral part of the neuroendocrine stress response during cardiac arrest. A strong correlation between endogenous AVP secretion and outcome from cardiac arrest has led to a number of experimental studies indicating a survival benefit of AVP compared to epinephrine. ⋯ Although current data suggest that both epinephrine and AVP are equally effective to restore spontaneous circulation in out-of-hospital cardiac arrest, benefits of AVP in specific patient groups, e.g. those with asystolic cardiac arrest, have been shown. The latest international guidelines recommend AVP as an alternative vasopressor drug which may replace the first or second dosage of epinephrine in the treatment of pulseless arrest If the combined use of AVP and epinephrine is superior to epinephrine alone in terms of improved hospital admission and discharge rates this needs to be re-confirmed by the results of an ongoing multicenter trial.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewRole of terlipressin in the treatment of infants and neonates with catecholamine-resistant septic shock.
The present paper is aimed at reviewing new findings on the use of terlipressin in children with septic shock. The level of evidence based on the data available in the literature is very low. Three series of cases and four isolated cases report on the use of terlipressin in children with catecholamine-refractory septic shock. ⋯ Mortality of these children with catecholamine refractory septic shock is 54%. The paucity of most reports does not make it possible to conclude on the global and microcirculatory effects of this treatment. Future studies are required before any recommendations on the use of terlipressin in children with septic shock can be made.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewVasopressin analogues in the treatment of hepatorenal syndrome and gastrointestinal haemorrhage.
Bleeding of oesophageal varices and hepatorenal syndrome are most dramatic complications in gastroenterology. They develop in consequence of progressively increasing blood flow entering the vasodilated splanchnic bed and the portal vein where blood flow meets intrahepatic resistance. Porto-systemic collateral veins are formed to bypass the cirrhotic liver. ⋯ This splanchnic blood pooling generates hypovolemia in the central and arterial system, initiating activation of the renin-angiotensin-aldosteron and sympathetic nervous system. These compensatory mechanisms induce renal vasoconstriction, followed by hypoperfusion of the kidneys and development of hepatorenal syndrome. Vasoconstrictors like terlipressin inhibit splanchnic blood flow, thus reducing portal and variceal pressure, which is followed by termination ofvariceal bleeding, by normalization of central and arterial blood volume and by an improvement of kidney function and hepatorenal syndrome.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewArginine vasopressin: a promising rescue drug in the treatment of uncontrolled haemorrhagic shock.
Haemorrhagic shock is one of the most frequent types of shock. If haemorrhage cannot be controlled and fluid resuscitation as well as catecholamines are insufficient to stabilize cardiovascular function, uncontrolled haemorrhagic shock occurs. Several approaches have been suggested as promising alternatives to volume resuscitation. ⋯ Particularly, when uncontrolled haemorrhage is accompanied by traumatic brain injury this may help to reduce secondary neurological damage. Since AVP can prevent acute death only transiently, it must comprehensively be combined with rapid hospital admission, immediate control of haemorrhage followed by aggressive fluid resuscitation and blood transfusion. This review article summarizes current experimental and clinical evidence on the use of AVP in uncontrolled haemorrhagic shock.