Throughout my training, I’ve placed countless pulmonary artery (“Swan-Ganz”) catheters for cardiothoracic surgeries and in the ICU to help guide the diagnosis and response to therapy in mixed or undifferentiated shock. These PA catheters gave me various pressures (central venous, pulmonary artery, sometimes right ventricular), the ability to draw true…
Epoprostenol (Veletri or Flolan) is an inhaled or intravenous prostanoid vasodilator which is most often used as a therapeutic option for pulmonary arterial hypertension (pHTN). When given intravenously, it dilates both the systemic and pulmonary arterial vasculature to decrease both systemic and pulmonary vascular resistances to augment cardiac output; however,…
Hydralazine (Apresoline) is an intravenous and oral antihypertensive that promotes the direct relaxation of arterioles through an unclear mechanism potentially involving calcium flux within the vascular smooth muscle. By acting primarily as a vasodilator (compared to venodilator), peripheral vascular resistance decreases causing the diastolic blood pressure to drop more than…
Hypothermia has a profound impact on the entire body – it compromises the immune system leading to a higher risk of post-operative wound infections, promotes coagulopathy, decreases drug metabolism and wound healing, delays emergence from anesthesia, alters mental status, and negatively affects hemodynamics. As an anesthesiologist and intensivist, I’m often…
Intraosseous (IO) access is a quick, relatively inexpensive, and simple route for obtaining “central” access in trauma and resuscitation settings when peripheral access is difficult to acquire. When placing an IO line, care must be taken to avoid fractured bones, active infections, and patients with underlying bone pathology like osteopetrosis.…
Dobutamine (Dobutrex) is a synthetic adrenergic agonist structurally similar to isoproterenol working on the same receptor profile – primarily beta 1 and beta 2 – to create the net effect of increased chronotropy (heart rate), inotropy (contractility) and vasodilation (decreased afterload). With these hemodynamic goals, dobutamine aims to increase forward…
Dopamine is a natural catecholamine that is the biochemical precursor to norepinephrine and epinephrine. In human physiology, it plays a pivotal role in regulating mood, lymphocyte activity, gastrointestinal motility, movement, the release of other neurotransmitters, and renal blood flow/sodium excretion. Specifically, dopamine decreases the release of prolactin from the anterior…
Methylene blue (ProvayBlue) is an intravenous medication and dye best known for treating methemoglobinemia but has been found to have potential benefits in other areas of medicine.
Isoproterenol (Isuprel) is a nonselective beta-adrenergic agonist structurally very similar to epinephrine, which I commonly use in the electrophysiology (EP) lab to induce tachyarrhythmias for the electrophysiologist to map out and ablate. Unfortunately, this medication is also a classic example of the price gouging imposed by pharmaceutical companies. Production rights…
