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Vasoconstrictors in the OR

Vasoconstrictors in the Operating Room (OR): Mechanisms of action and clinical findings Indirect effects of ephedrine Ephedrine Intraoperative use if patient becomes: -Hypotensive -Bradycardic Inhibits reuptake of neuronal norepinephrine Bind to alpha-1 receptors in peripheral vasculature Bind to beta-1 receptors in cardiac tissue Bind to beta-2 receptors in pulmonary tissue Bind to alpha-1 receptors in peripheral vasculature Bind to alpha-1 receptors in iris dilator muscle (for opthalmic administration) Norepinephrine remains in synapse longer ↑ Norepinephrine release from storage vesicles Peripheral vein vasoconstriction ↑ Sinoatrial & atrioventricular nodal firing & inotropy (force of heart’s muscle contractions) Relaxes airway smooth muscle Vasoconstricts peripheral veins & arteries Iris dilator (smooth muscle) contraction Binds to alpha-1 receptors in peripheral vasculature Binds to beta-1 receptors in cardiac tissue Binds to beta-2 receptors in pulmonary tissue ↑ Blood pressure ↑ Systemic vascular resistance ↑ Heart rate ↑ Cardiac contractility ↑ Cardiac output Bronchodilation ↑ Blood pressure ↑ Preload ↑ Afterload ↑ Systemic vascular ↑ Blood pressure ↑ Heart rate ↑ Cardiac contractility Bronchodilation Sustained tachycardia (Heart rate >100 beats per minute) Arrhythmias (abnormal heart rhythms) Palpitations Baroreceptor mediated reflex bradycardia (Heart rate <60 beats per minute) ↓ Reduced cardiac output (when afterload > preload) Direct effects ephedrine of Phenylephrine Intraoperative use patient becomes: -Hypotensive if resistance Pupil dilation Authors: Rebecca Sugars Reviewers: Run Xuan (Karen) Zeng, Luiza Radu, Leyla Baghirzada* * MD at time of publication Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Jan 28, 2025 on www.thecalgaryguide.com