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 the haemodynamic stability in the perioperative and the critically ill patient. The framework rests on the receptor pharmacology (the alpha-1, the beta-1, the beta-2, the V1, the D1), the agents (the metaraminol, the phenylephrine, the ephedrine, the noradrenaline, the adrenaline, the vasopressin; the dobutamine, the milrinone, the levosimendan), the indications (the anaesthesia-induced hypotension, the vasoplegic shock, the cardiogenic shock, the septic shock), and the administration (the bolus vs the infusion, the central vs the peripheral).
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8 MCQs with explanations
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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?[1]
The answer depends on one number: the heart rate. 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.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
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- [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