Nitric oxide is a molecule normally made by vascular endothelial cells to decrease vascular resistance in both the systemic and pulmonary circulations. Inhaled nitric oxide (iNO) is an (expensive) pulmonary dilator I frequently use in the OR and ICU settings for patients with acute right heart failure, refractory hypoxemia, pulmonary…
Compared to catecholamine infusions which are routinely titrated, there’s a polarized practice with vasopressin – those who titrate and those who don’t. As a resident, I worked with intensivists who strongly believed in “0.04 U/min or nothing at all.” They believed that similar to electrolyte repletion, vasopressin at this fixed…
One of the cardiopulmonary challenges I constantly face as a cardiothoracic anesthesiologist and intensivist is balancing positive end-expiratory pressure (PEEP) with cardiac output (CO). CO is related to the heart rate (HR) and stroke volume (SV), the latter of which is related to preload, afterload, ventricular compliance, and contractility. Although…
The induction of general anesthesia in patients undergoing cardiac surgery is often times different than non-cardiac surgery. At many institutions, these inductions tend to center heavily around high dose opioids due to the hemodynamic stability conferred by narcotics. When talking about fentanyl, this translates to anywhere from 50 – 100…
Cyanokit (hydroxocobalamin, a form of vitamin B12) is an injectable therapy most often used to treat cyanide toxicity. This medication readily combines with cyanide to form cyanocobalamin thereby freeing cytochrome c oxidase to proceed with aerobic respiration in the electron transport chain.
Phentolamine (Regitine) is a reversible α-1 and α-2 blocker used primarily for its vasodilatory effects. When used to control hypertension, one must consider the autonomic effects of blocking these receptors.
Sodium nitroprusside (SNP, Nipride/Nitropress) is a short-acting, intravenous antihypertensive that directly acts on venous AND arteriolar smooth muscle to cause vasodilation decreasing preload, afterload, and left ventricular (LV) impedance. As an intensivist and cardiac anesthesiologist, I like to separate venodilation from vasodilation with separate agents, so I don’t use nitroprusside…
Verapamil (Calan/Verelan) is an oral and intravenous non-dihydropyridine calcium channel blocker (CCB) which is more selective for L-type calcium channels on cardiac muscle than vascular smooth muscle. In comparison, dihydropyridine CCBs like nicardipine and clevedipine cause more vasodilation.
Metoprolol (Lopressor) is a selective beta-1 receptor blocker used primarily to decrease heart rate (chronotropy) and cardiac contractility (inotropy) in those with anginal chest pain, acute myocardial infarctions, supraventricular tachycardias, and even off-label for anxiety disorders.
Nitroglycerin (NTG) is short-acting venodilator (vasodilator at higher doses) which, like all nitrates, is converted to nitric oxide to exert its effects. In medicine, NTG is routinely used to improve the mismatch between cardiac oxygen supply and demand by dilating the coronary arteries as well as the large venous capacitance…