Anaes · Vasopressors & inotropes
Vasopressors & inotropes
Also known as Vasopressors · Inotropes · Vasoactive agents · Metaraminol · Phenylephrine · Noradrenaline · Vasopressin · Adrenaline · Dobutamine · Milrinone
The vasopressors and the inotropes are the vasoactive agents used to maintain haemodynamic stability in the perioperative and critically ill patient. The framework rests on taught receptor pharmacology (alpha-1, beta-1, beta-2, V1), HPI-guided haemodynamic management reducing hypotension and phenylephrine use (Xie 2026, 19 RCTs), the post-cardiac-surgery vasoplegia algorithm with first-line norepinephrine plus early vasopressin (Chatterjee 2026), safe peripheral vasopressor administration under protocol (Singh 2026), and calcium as a transient, evidence-limited adjunct in cardiothoracic weaning (Miller 2026). Doses are taught-formulary.
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Target exams
Red flags
- Match the vasoactive drug to the physiology: vasoplegia responds to alpha-agonists (metaraminol, phenylephrine, noradrenaline — taught); low output responds to inotropes (adrenaline, dobutamine, milrinone — taught); refractory post-CPB vasoplegia escalates from first-line norepinephrine to early vasopressin (Chatterjee 2026). The blind vasopressor without haemodynamic assessment is the error — cause first.
Meet the patient
A 30-year-old woman receives a spinal for an emergency Caesarean. Within three minutes her blood pressure is 80/40 and her heart rate is 45. The fetal heart rate is dropping. You have phenylephrine and ephedrine drawn up — which do you reach for? (Taught scenario; drug choice taught-formulary.)[3]
The answer depends on one number: the heart rate (taught principle). Bradycardic and hypotensive under a spinal means ephedrine (or treat the bradycardia). Vasodilated with a normal or high rate means phenylephrine or metaraminol. That single principle — pick by heart rate — is the spine of the topic.[3]
References4ShowHide
- [1]Xie CM, et al. Hypotension prediction index in surgical patients: A systematic review and meta-analysis of randomized controlled trials Medicine (Baltimore), 2026.PMID 42299539
- [2]Miller A, et al. The effect of intravenous calcium administration on haemodynamics in perioperative cardiothoracic surgery and intensive care: A narrative review Crit Care Resusc, 2026.PMID 42016282
- [3]Chatterjee S, et al. Management Algorithm for Vasoplegic Shock after Cardiac Surgery: An Interdisciplinary Collaboration Ann Thorac Surg, 2026.PMID 42309294
- [4]Singh O, et al. Navigating the veins: A comprehensive review of vasoactive agent infusion via peripheral routes World J Crit Care Med, 2026.PMID 42272888