Inotropes, Vasopressors and Vasodilators

Abstract

Indications, selection and duration of inotropic support during and following cardiac surgery remain variable and controversial. Nevertheless, it is employed frequently for anticipated or manifest hemodynamic instability ranging from low cardiac output to established shock stages. This chapter provides a background, justification and overview of inotropic and vasopressor therapy with a strong clinical rather than molecular and pharmacological focus. Current treatment strategies and principles of crucial aspects of medical management are discussed. The main clinical classification of inotropes and to a lesser degree vasoactive agents is included as well as clinical utilities of the most frequently used agents are described. Due to the significance of right ventricular dysfunction a section is dedicated to the right ventricle and pulmonary circulation. Finally, a summary of treatment strategies for the most common clinical scenarios is provided.