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Effects of Vasopressors on Cerebral Circulation and Oxygenation

A Narrative Review of Pharmacodynamics in Health and Traumatic Brain Injury

Thorup, Line MD*; Koch, Klaus U. MD*; Upton, Richard N. BSc, PhD; Østergaard, Leif MD, PhD, DMSC; Rasmussen, Mads MD, PhD*

Journal of Neurosurgical Anesthesiology: April 03, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/ANA.0000000000000596
Review Article: PDF Only

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.

*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, Department of Anesthesia and Intensive Care, Section of Neuroanesthesia, Aarhus University Hospital, 8000 Aarhus C, Denmark (e-mail:

Received December 7, 2018

Accepted February 27, 2019

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