Hemodynamic Defects Underlying Shock with Indications for Treatment: An Appraisal of Vasopressors and Vasodilators
Until the sphygmomanometer came into wide use after 1910, the character and rate of the pulse served as the primary objective measure of severity of circulatory failure. Subsequently, blood pressure became an index for both the diagnosis and estimation of severity of the shock state. In the search for therapy by which hypotension could be reversed, the clinician was attracted to drugs restoring blood pressure to more normal levels. This led to the early use of epinephrine and the subsequent use of its adrenergic analogs. Beginning in the 1940s synthetic adrenergic drugs came into wide use for treatment of shock states. Unlike epinephrine, phenylephrine and methaxamine increased blood pressure but more often decreased the heart rate. Except for the relatively conservative use of fluids, blood, blood components, and blood substitutes, vasopressor drugs were until recently the mainstay of therapy for shock, regardless of cause.
KeywordsShock State Fluid Challenge Arteriovenous Shunting Arterial Resistance Vasopressor Agent
Unable to display preview. Download preview PDF.
- 1.Ahlquist, R. P. (1948). A study of adrenotropic receptors. Am. J. Physiol. 755:586–600.Google Scholar
- 4.Cournand, A., et al. (1943). Studies of the circulation in clinical shock. Surg. 73:964–995.Google Scholar
- 7.Hershey, S. G., et al. (1964). Influence of a synthetic analogue of vasopressin on survival after hemorrhagic shock in rats. Proc. Soc. Exp. Biol. Med. 775:325–328.Google Scholar
- 8.Lillehei, R. C., Longerbeam, J. K., and Bloch, J. H. (1964). The nature of experimental irreversible shock with its clinical implications. In: Hershey, S. G. (ed.), Shock. Boston: Little, Brown, pp. 139–205.Google Scholar
- 12.Shnider, S. M., Lorimier, A. A., and Hefferson, J. L. (1970). Vasopressors in obstetrics: III. Fetal effects of metaraminol infusion during obstetrical spinal hypotension. Am. J. Obstet. Gynec. 705:1017–1022.Google Scholar
- 15.Taylor, S. H., et al. (1965). The circulatory effects of intravenous phentolamine in man. Circulation 37:741–754.Google Scholar
- 17.Weil, M. H., and Shubin, H. (1967). Diagnosis and Treatment of Shock. Baltimore: Williams and Wilkins, p. 10.Google Scholar
- 18.Weil, M. H., and Shubin, H. (1972). Proposed reclassification of shock with special reference to distributive defects. In: Hinshaw, L. B., and Cox, B. G. (eds.), The Fundamental Mechanisms of Shock. New York/London: Plenum, pp. 13–23.Google Scholar