The controlled use of vasodilator drugs in the management of hypovolaemia complicated by diminished cardiac function

Abstract

The fundamental importance of precise measurement of cutaneous temperature rather than the cursory assessment with the back of the hand in cases of shock or diminished tissue perfusion has been well described by Ross, Brock, and Aynsley-Green (1969). They showed examples where core/toe temperature gradients reflected hypovolaemia in postoperative cardiac surgical patients and further showed how this information could be used to guide α-blockade therapy to overcome peripheral vasoconstriction, thus allowing rapid correction of hypovolaemia by transfusion. One criticism levelled by antagonists to this form of treatment is that α-blockade drugs cause hypotension. This article shows that with careful control α-blockade should not cause significant hypotension. Furthermore, in patients with hypotension of cardiogenic origin, α-blockade may be safely used in the treatment of coincidental hypovolaemia.