Anestéziológia a intenzívna medicína 1/2018
Vazoplégia po kardiochirurgickom zákroku
Vasoplegic syndrom after cardiac surgery
Vasoplegic syndrom after cardiac surgery, characterized by hypotension, low systemic vascular resistance in the presence of normal cardiac output is a frequent complication of cardiovascular surgery. It is associated with a diffuse systemic inflammatory response of the organism, mediated through cell hyperpolarization, high levels of inducible nitric oxide and a relative deficiency of vasopressin. Cardiosurgery is strong trigger of the vasoplegic syndrome, due to its association with nitric oxide production and vasopressin deficiency. Postoperative vasoplegic shock is managed with vasopressors, of which norepinephrine is considered to be the first-line agent. Recent investigations support the use of noncatecholamine vasopressors, vasopressin in particular, to restore vascular tone. Alternative agents, including methylene blue, hydroxycobalamin, corticosteroids, and angiotensin II, also are capable of restoring vascular tone, but their mechanism of action and effect on survival is unclear.
Keywords: pathophysiology of vasoplegic shock, cardiopulmonary bypass, nitric oxide, norepinefrin, vasopressin
