1 / 25

Inotropes in Cardiac Surgery

Inotropes in Cardiac Surgery. Basics. Cardiac Cycle. Phase 1 - Atrial Contraction Phase 2 - Isovolumetric Contraction Phase 3 - Rapid Ejection Phase 4 - Reduced Ejection Phase 5 - Isovolumetric Relaxation Phase 6 - Rapid Filling Phase 7 - Reduced Filling. Sympathetic / Parasympathetic.

rose-horn
Download Presentation

Inotropes in Cardiac Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Inotropes in Cardiac Surgery

  2. Basics

  3. Cardiac Cycle • Phase 1 - Atrial Contraction • Phase 2 - Isovolumetric Contraction • Phase 3 - Rapid Ejection • Phase 4 - Reduced Ejection • Phase 5 - Isovolumetric Relaxation • Phase 6 - Rapid Filling • Phase 7 - Reduced Filling

  4. Sympathetic / Parasympathetic

  5. Starlings Law

  6. BEFORE INOTROPES • Fluid • Bolus • Legs up • Rhythm • ECG, SR, slow, fast, paced on ventricle, ST’s, ectopics • Tamponade • CVP, BE, UO, temp, CXR, echo • Bleeding • Drains, CXR, Hb • Pneumothorax • CXR, examine, vent alarms • Fight Ventilator • Paralyse, sedate or extubate

  7. Which Inotrope • Ohms Law • V=I x R • BP=CO x SVR • Simple terms • Low or high cardiac output, what is the PA pressure

  8. Inotropes • Atropine • Ca2+ • Dopamine • Dopexamine • Dobutamine • Adrenaline • Noradrenaline • Isoprenaline • Enoximone • Aminophylline • Vasopressin • Methylene blue • NO

  9. Receptors

  10. Atropine • Antimuscurinic ie causes tachycardia • Some pateints have muscurinic receptors on ventricle as well ie inotropic • Increases HR • CO=SV x HR

  11. Ca2+ • Inotrope and vasoconstrictor • Short acting • Beware radial artery patients • Warn patient if awake

  12. Dopamine • Acts on dopamine receptors on heart and kidney • Causes a tachycardia (CO=SV x HR) • Increases urine output in some patients • Less metabolic side effects compared with adrenaline • Beware patients with tachycardia (give k+, Mg2+)

  13. Dopexamine • Tachycardia • Increase splanchnic and renal blood flow • VASODILATOR • Beware • Vasodilated patients

  14. Dobutamine • Like dopamine • Has less effect on pulmonary artery pressure good for mitral valve patients

  15. Adrenaline • Excellent inotrope but dirty • Increased heart rate and inotropy (ß1-adrenoceptor mediated) • Vasoconstriction in most systemic arteries and veins (postjunctional a 1 and a 2 adrenoceptors) • Vasodilation in muscle and liver vasculatures at low concentrations (b2-adrenoceptor); vasoconstriction at high concentrations (a1-adrenoceptor mediated)

  16. Adrenaline

  17. Noradrenaline • Vasoconstrictor • Increased heart rate and increased inotropy (ß1-adrenoceptor mediated) • Vasoconstriction occurs in most systemic arteries and veins (postjunctional a 1 and a 2 adrenoceptors) • Ask can I wake patient up to avoid Norad • Must have a good cardiac output

  18. Noradrenaline

  19. Isoprenaline • Causes tachycardia and vasodilatation • Good in patients with high PA pressures • Beware vasodilated patients

  20. Enoximone Phosphodiesterase Inhibitor Good in patients with high PA pressure “2nd line when adrenaline having no effect “receptor dissociation”

  21. Aminophylline • Phosphodiesterase inhibitor • Main effect on lung compared to heart • Good in patients who have hypoxic vasoconstriction “short fat little smoker with poor urine output”

  22. Vassopresin • 2nd line vasoconstrictor • Most powerful available • Associated with organ ischaemia

  23. Methylene blue • Whatever the mechanism the final step of vasodilatation is NO • Methylene blue inhibits NO synthesis

  24. Nitric Oxide

  25. What else • IABP • LVAD • RVAD • BVAD

More Related