Inotropes

1. APPRECIATING
INOTROPES

2. Quick drill
INOTROPE RECEPTORS EFFECTS USES SIDE EFFECTS
Adrenaline
Noradrenaline
Dopamine
Dobutamine
Milrinone
Phenylephrine

3. Equation of Life
DO2 = CO x oxygen content
CO = SV x HR
O2 Content = (Hb x 1.34 x SaO2) + (PaO2 x 0.003)
MAP = CO x TPR

5. • INOTROPY
• CHRONOTROPY
• LUSITROPY
• VASOACTIVE
• VASOPRESSOR
• VASODILATOR
• INODILATOR

6. AGENT PHYSIOLOGIC RESPONSE END RESULT EXAMPLES
Inotrope  Cardiac contractility  CO
 BP same or 
Dobu, Dop, Mil, Adren
Chronotrope  HR CO
HR
Adr, Dop, Dobu (High
dose)
Lusitrope Diastolic relaxn of
ventricles
 CO if diastolic
dysfunction present
Mil
Vasopressor  SVR and PVR BP
CO  or 
Nor, Adr, Vasopressin,
Dop (high dose)
Vasodilator  Art+Ven tone
SVR and PVR
BP  or 
 CO
SNP, Mil
Inodilator  Cardiac contractility
SVR and PVR
 CO
BP  or 
Mil, Dob, Levosimendan

8. Revising our receptors

12. USES
- CPR, Anaphylaxis, Croup / UAO, Cold shock (decompensated, especially if bradycardic
and hypotensive)

21. Q1
• 3 month old shocked gastro – had 40ml/kg fluid.
• Liver now 2cm.
• HR 180. BP 55/30 (40). CRT 4secs.
• Lactate 4

22. Q2
•8 year old AML with neutropenic sepsis.
•Had 40ml/kg fluid
•HR 140, BP 70/30 (50)
•Lactate 8

23. Q3
• 6 month old with SOB, displaced apex and large heart on CXR
• No murmur
• HR 180, BP 75/40, CRT 4 secs,
• Liver 5cm
• Worsened after 10ml/kg bolus
• Lactate 5

24. Q4
• 5 day old 29/40 1.2kg prem with distended abdo referred from
SGH
• HR 190, BP 40/20
• K 6, Lactate 6
• Had 30ml/kg fluid boluses with minimal effect
• On 15mcg/kg/min dopamine

25. What inotrope
• Cold Shock
• Adrenaline
• Warm Shock
• Noradrenaline
• Adrenaline drug of choice in anaphylactic shock
• Cardiogenic Shock
• Dobutamine, Adrenaline, Milrinone