Vasoconstrictor Responses to Vasopressor Agents in Human Pulmonary and Radial Arteries

Abstract

Sympathomimetic-based vasopressor agents constrict both human radial and pulmonary arteries with similar potency in each. In contrast, vasopressin, although a potent vasoconstrictor of radial vessels, had no effect on pulmonary vascular tone. These findings provide some support for the use of vasopressin in patients with pulmonary hypertension.

Influence of central apneas and chemoreflex activation on pulmonary artery pressure in chronic heart failure

“…Therefore, during a central apnea, the simultaneous effect of direct vasoconstriction determined by concurrent hypoxia/hypercapnia and the chemoreflex induced adrenergic stimulation may impact on the pulmonary vasculature [38], as already reviewed in detail [39].…”

Should Norepinephrine, Rather than Phenylephrine, Be Considered the Primary Vasopressor in Anesthetic Practice?

“…There have been no comparative studies of this potential; however, NE and PE vasoconstriction have been compared in ex vivo human radial arteries. 19 NE was found to be 7× more potent than PE in radial arteries. The relative vasoconstrictor potential in human saphenous veins in vivo has also been studied.…”

“…13,14 An increase in venous resistance is not found with NE, which has both α 1 and β 1 effects as well as some β 2 effects, 7 resulting in a β-induced venous vascular relaxing effect on venous resistance. Hence, NE better enhances venous return to the heart and so CO. 14,15 The β 1 effects also result in a positive inotropic effect on the myocardium with little to no chronotropic effect when compared with E. 6 Thus, NE increases arterial blood pressure through arteriolar vasoconstriction and an increase (or maintenance) of heart rate, stroke volume, and CO. [16][17][18][19] NE is the neurotransmitter of the sympathetic nervous system. 20 Plasma levels are reported as being 264 ± 162 pg/mL (mean ± SD; n = 27) before induction of anesthesia with thiopental and 127 ± 78 pg/mL afterward, during isoflurane and sufentanil anesthesia.…”

Mechanical circulatory support

“…Preoperative low LV ejection fraction, prolonged CPB, and preoperative ACEI intake are risk factors. Vasoplegic syndrome is best treated by the infusion of vasopressin, which increases MAP with negligible effects on PVR [59,60]. Severe vasoplegia may require the use of multiple vasopressors such as dopamine, norepinephrine, and methylene blue (in refractory vasoplegia).…”