Review ArticlesEffects of Vasopressors on Cerebral Circulation and Oxygenation: A Narrative Review of Pharmacodynamics in Health and Traumatic Brain InjuryThorup, Line MD*; Koch, Klaus U. MD*; Upton, Richard N. BSc, PhD†; Østergaard, Leif MD, PhD, DMSC‡; Rasmussen, Mads MD, PhD*Author Information *Department of Anesthesia and Intensive Care, Section of Neuroanesthesia ‡Department of Neuroradiology and Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark †Australian Centre for Pharmacometrics, University of South Australia, Adelaide, SA, Australia M.R. was funded by the Health Research Fund of Central Denmark Region, Viborg, Denmark. The remaining authors have no conflicts of interest to disclose. Address correspondence to: Mads Rasmussen, MD, PhD. E-mail: [email protected]. Journal of Neurosurgical Anesthesiology: January 2020 - Volume 32 - Issue 1 - p 18-28 doi: 10.1097/ANA.0000000000000596 Buy Metrics Abstract The clinical use of vasoactive drugs aims to improve hemodynamic variables and thereby maintain or restore adequate perfusion and oxygenation in accordance with metabolic demands. A main focus in the management of patients with brain pathology during surgery and neurointensive care is restoring and/or maintaining adequate cerebral perfusion pressure in order to ensure cerebral blood flow in accordance with metabolic demands. One commonly used clinical strategy is the administration of vasoactive drugs aiming to increase mean arterial blood pressure and thereby cerebral perfusion pressure. Here, we first describe the anatomic and physiological basis for the cerebrovascular effects of vasopressor agents. Next, we review the pharmacodynamics of commonly used vasopressors under normal circumstances and in the presence of head injury. We further discuss the role of blood-brain barrier disruption and microvascular dysfunction with regard to the effects of the reviewed vasopressor agents. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.