Epinephrine as an inotropic agent in septic shock

Bilateral Toe Necrosis Resulting from Norepinephrine Bitartrate Usage

“…A 1 adrenergic receptors are most common in the heart and mediate increases in inotropy and chronotropy with minimal vasoconstriction. 6,7 Complications of drug use may include, but are not limited to, cardiovascular arrhythmias, bradycardia, peripheral (digital) ischemia, central nervous system anxiety, headache (transient), local skin necrosis with extravasation, and respiratory dyspnea. The necrosis of the toes as seen in this rare case was symmetric, involving both feet as opposed to the necrosis generally seen in an embolic event, which is usually asymmetric.…”

Vasopressor and inotropic support in septic shock: An evidence-based review

“…Moran et al (72) reported a linear relationship between epinephrine dose and heart rate, mean arterial pressure, cardiac index, left ventricular stroke work index, and oxygen delivery and consumption. Epinephrine, however, has variable and often detrimental effects on splanchnic blood flow and causes transient decreases in pHi and increases in the PCO 2 gap (51,63,73).…”

Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study

“…Dobutamine and/or dopamine often fail to restore adequate perfusion pressure. There is ample evidence that either epinephrine or the combination norepinephrine-dobutamine are able to increase arterial pressure without deleterious effect or with favorable effects on oxygen delivery in septic shock [1][2][3][4][5][6][7]. Nevertheless, both the gastrointestinal tract and the liver may be inadequately perfused despite the presence of normal systemic measures of the adequacy of tissue oxygenation [8].…”