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Vasopressor / Inotrope

Vasopressin

ADH analog (V1 vasoconstrictor)

Mechanism: V1 receptor agonism → vasoconstriction independent of adrenergic system.

Onset
1–3 min
Duration
10–20 min
Metabolism
Hepatic & renal.

Dosing

Adult
Infusion 0.01–0.04 U/min (fixed).

Indications

  • Septic shock adjunct
  • Vasoplegia (post-CPB)
  • Cardiac arrest (deprecated in ACLS)

Contraindications

  • Coronary ischemia (high dose)

Side Effects

  • Splanchnic ischemia
  • Hyponatremia

Clinical Pearls

1Catecholamine-sparing — useful when escalating norepinephrine doses cause tachyarrhythmia.

References & Further Reading

  1. 1
    Textbook

    Flood P, Rathmell JP, Shafer S. Stoelting's Pharmacology and Physiology in Anesthetic Practice. 5th ed. Philadelphia: Wolters Kluwer; 2015.

  2. 2
    Guideline

    Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e1143.

  3. 3
    Textbook

    Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

  4. 4
    Textbook

    Adriano A, Morris R, eds. 2021 CA-1 Tutorial Textbook (15th Ed.). Stanford University Medical Center, Department of Anesthesiology.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.