Pharmacological modulation of cardiac function and blood vessel calibre

Publication date: Available online 20 November 2018

Source: Anaesthesia & Intensive Care Medicine

Author(s): Christopher P. Hebbes

Abstract

Inadequate end organ perfusion and tissue hypoxia is an end point of many disease processes in critical illness. Maintenance of organ perfusion and therefore tissue Oxygenation is critical to patient management in the perioperative period. Global blood flow is determined by a balance of neurohormonal factors, with autoregulation ultimately determining local flow. These factors modulate cardiac output and vasomotor tone. Pharmacological manipulation of both the myocardium and vasculature at the level of the autonomic nervous system (via α or β adrenoceptors), cardiac muscle (e.g. calcium sensitisation via Levosimendan), or locally (e.g. via regional or neuraxial local anaesthetic blockade) is commonly used in anaesthesia to mitigate the effects of critical illness and perioperative stress responses. This enables maintenance of organ perfusion through modulating vascular tone or cardiac output. This article considers the global control of the system through to local and regional regulation of blood flow, and how the system may be manipulated at every level.

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