Best practice & research. Clinical anaesthesiology
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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.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewPhysiology and pathophysiology of the vasopressinergic system.
Arginine vasopressin, a hypothalamic peptide hormone, has multiple physiological functions, including body water regulation, control of blood pressure and effects on body temperature, insulin release, corticotropin release, memory and social behaviour. These functions are achieved via at least three specific G-protein-coupled vasopressin receptors. ⋯ The complex signalling and messenger processes which take place after receptor stimulation are now more clearly understood. Vasopressin dysregulation can occur in various disease processes, and a better understanding of the mechanisms underlying physiological synthesis, release and regulation of vasopressin will help in the development of therapies to treat these conditions.
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Best Pract Res Clin Anaesthesiol · Jun 2008
ReviewImpact of vasopressin analogues on the gut mucosal microcirculation.
Given the controversial experimental and clinical data reported in the literature, up to now it is rather difficult to draw a definitive conclusion on the effects of V1 agonists on splanchnic haemodynamics. Nevertheless, it must be underscored that most of the experimental studies assessing the effects of low dose V1 agonist infusion in hyperdynamic models did not demonstrate any detrimental effect on splanchnic haemodynamics both at macro- and microcirculatory levels. ⋯ In clinical studies in patients with septic shock, data are accumulating regarding the absence of clinically relevant side effects in the splanchnic region when vasopressin is used, but conversely little is known about the safety of terlipressin, mainly because of the small number of patients studied. Thus, the absence of clinically harmful effect does not exclude covert splanchnic ischaemia, which may counterbalance the beneficial systemic effects.