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Sat Jul 28 18:08:43 BST 2007

I'm not sure what the answer to the first question is, but ( and this is
pure
speculation)i think that the correction of acidosis which takes place
when vasopressin is started in patients with septic shock
seems to indicate that the microcirculation is probably improving, possibly
by reducing metacapillary shunting. with respect to the second point, i'm
reluctant to use ketamine in a patient who has exhausted his catecholamine
reserve secondary to prolonged shock since i feel that the direct depressant
effects of ketamine will be unmasked.
rangraj.

On 7/28/07, IVAN HRONEK <ih7 at msn.com> wrote:
>
> Vasopressin during uncontrolled hemorrhagic shock: less bleeding below the
> diaphragm, more perfusion above.Stadlbauer KH - Anesth Analg -
> 01-SEP-2005; 101(3): 830-2Vasopressin in hemorrhagic shock.Sharma RM -
> Anesth Analg - 01-SEP-2005; 101(3): 833-4, table of contentsWe describe the
> treatment of two patients with hemorrhagic shock unresponsive to volume
> replacement and catecholamines. Both patients responded to a small-dose
> infusion of vasopressin, which allowed tapering off of the catecholamines.
> The possible role of small-dose infusions of vasopressin in fluid- and
> catecholamine-resistant hemorrhagic shock is discussed. Should the patients
> be kept (after the initial phase) vasodilated with borderline pressure, or
> vasoconstricted (vasopressin) with borderline pressure ?This would decrease
> the amount of crystalloids that we overuse so much..and in this respect, how
> about Ketamine instead of Fentanyl ?Ivan Hronek MDChief, Critical Care &
> Trauma AnesthesiaSFMC Gas, Inc.St. Francis Medical Center3630 E. Imperial
> HighwayLynwood, CA 90262 Cell: 310 487-3288Pager: 310 636-6020
>
> > Date: Tue, 24 Jul 2007 06:48:53 +0200> From: jacob.scholz at gmail.com> To:
> trauma-list at trauma.org> Subject: Vasopressin in haemorrhagic shock -
> Vasopressin vs Fluid> > After having read the thread about massive
> transfusion protocols I received> an e-mail with the following article:> >
> Vasopressin improves survival in a porcine model of abdominal vascular>
> injury> Critical Care 2007, 11:R81 doi:10.1186/cc59772007, 11:R81 doi:
> 10.1186/cc5977> The authors conclude:> "Vasopressin, but not fluid
> resuscitation or saline placebo, ensured> short-term survival in this
> vascular injury model with uncontrolled> haemorrhagic shock in sedated
> pigs."> > They were pigs and they were not transfused, but what does the
> list think> about vasopressin, maybe in conjunction with transfusion, in
> human> haemorrhagic shock?> > Jacob> --> trauma-list : TRAUMA.ORG> To
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-- 
Lt Col Rangraj Setlur
Associate Professor
Department of Anaesthesiology and Critical Care
Armed Forces Medical College
Pune
India

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Vasopressin in haemorrhagic shock - Vasopressin vs Fluid