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35 - Vasopressin and other non-adrenergic vasopressors
- from Part IV - Therapy of sudden death
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- By Anette C. Krismer, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Martin Dunser, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Karl H. Stadlbauer, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Karl H. Lindner, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria, Volker Wenzel, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
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- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 647-666
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Summary
Basic science
The importance of arterial vascular tone in resuscitation from cardiac arrest has been described in detail in the previous chapters of this book.
Efficacy of non-adrenergic pressors
There is a longstanding concern that administration of adrenaline during resuscitation may result in detrimental effects during the postresuscitation period. Forexample, laboratory studies with adrenaline during cardiopulmonary resuscitation (CPR) showed increased myocardial oxygen consumption, ventricular arrhythmias, ventilation–perfusion defects, and postresuscitation myocardial dysfunction. Therefore, non-adrenergic vasoactive peptides such as vasopressin hold considerable promise, since theymayraise perfusion pressure without the β-receptor-mediated side effects of adrenergic vasopressors. Another intriguing possibility is that they may act synergistically when administered together with catecholamines, and that concomitant use of adrenergic drugs and nonadrenergic vasoactive peptides may allow lowering of the dose of each agent.
Vasopressin, an endogenous stress hormone
A number of fundamental endocrine responses of the human body to cardiac arrest and CPR have been investigated in past years, and are summarized in another chapter of this book. Circulating endogenous vasopressin concentrations were high in patients undergoing CPR, and levels in successfully resuscitated patients have been shown to be significantly higher than those in patients who died. This may indicate that the human body discharges vasopressin as an adjunct endogenous vasopressor to epinephrine in life-threatening situations such as cardiac arrest in order to preserve homeostasis. In a clinical study of 60 out-of-hospital cardiac arrest patients, parallel increases in plasma vasopressin and endothelin during CPR were found only in surviving patients. Thus, plasma concentrations of vasopressin may have a more important effect on CPR outcome than was previously thought. These observations prompted several investigations to assess the role of arginine vasopressin in the management of CPR in order to improve patient outcome.
7 - The neuroendocrine response to global ischemia and reperfusion
- from Part II - Basic science
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- By Martin W. Dünser, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria, Stefan Jochberger, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria, Karl-Heinz Stadlbauer, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria, Volker Wenzel, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
-
- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 128-162
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- Chapter
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Summary
The neuroendocrine system
Early during evolution, the neuroendocrinium developed as its own organ system. With its numerous intercellularand inter-organ mediators, the hormones, it fulfills important functions to synchronize and connect organs and tissues. Likewise, during stress, the neuroendocrine system, as a complex orchestra with not yet fully understood interactive mechanisms, plays one of the most important roles in the body's adaptation to harmful events, such as injury or disease.
Operational definitions (by Jacobo Wortsman, M.D.)
In general terms the endocrine system comprises hormone-producing organs (glands) that regulate the function of other organs. On functional activation, endocrine organs release their secretory products into the blood. Thus, activation can be assumed to occur when there is evidence of increased hormone concentrations in plasma.
Stress may be defined as any changes in the external or internal environment that elicit a highly organized and synchronized neuroendocrine response. Whereas changes in the internal environment can be quantified according to the degree of interference with homeostasis, changes in the external environment (psychologic stress) cannot be quantified in this manner. Thus, the description of stress must include both the nature of the stressful stimulus and the subsequent functional changes. Nevertheless, because of the universal and severe organ involvement during cardiac arrest, it can be safely assumed that this condition per se represents a stress of maximal degree, without consideration of hormone levels.
The term neuroendocrine response, as used in the description of endocrine reactions to stress, emphasizes the regulatory control placed by the hypothalamus over the entire endocrine system.