Aramine/Metaraminol as a pressor in Septic Shock

[BushyFromOz]

Anyone using it prehospitally or critical care?

[Kiwiology]

Nope. We do have adrenaline tho as a 1:1,000,000 infusion (i.e. 1 mg in 1,000 ml) provided after a minimum of 2 litres of fluid the patient is still hypotensive.

[BushyFromOz]

How man mics a minute do you run that at kiwi?

[Kiwiology]

We run it at two drops per second initially then titrate to effect

So let's say we use a 20 gtt/ml set then that's be hmm let's see here, Kiwi math not so good ... 0.006 mg (or 6 mcg/min)

[BushyFromOz]

I thought this would get more interest

[Kiwiology]

It's because nobody can understand us, you are an Australian so by default you are barely understandable because you're pissed 24/7 and me, well I'm so bloody destroyed on lorazepams that I can barely contain my faculties ....

I am curious as to the use of an alpha agonist like metaraminol vs a beta agonist like adrenaline as to which produces a better effect. I think we use adrenaline primarily because it's already in the toolbox ...

[BushyFromOz]

It's because nobody can understand us, you are an Australian so by default you are barely understandable because you're pissed 24/7 and me, well I'm so bloody destroyed on lorazepams that I can barely contain my faculties ....

I am curious as to the use of an alpha agonist like metaraminol vs a beta agonist like adrenaline as to which produces a better effect. I think we use adrenaline primarily because it's already in the toolbox ...

I spoke to someone from medical standard the other day about this, basically said the evidence for norad over adrenaline was very thin. I cant find anything that categorically says that norad improves outcomes or reduces mortality, just some cautions on side effects and transient lactataemia with adrenaline

This has come up in a theoretical discussion in the management of an octogeneric septic shock patient with tachycardia. We don't have norad but aramine is on the vehicles. I was kind of wondering if anyone has seen it used prehospitally, I know CCU has used it here at times.

And I'm only drink 12 hours a day thanks =D

Edited November 22, 2013 by BushyFromOz

[Off Label]

Norepinepherine (levophed) is the first line pressor of choice in the setting of septic shock at most places I'm aware of. If there are no significant contractility issues, epinephrine doesn't make sense. NE is usually chosen over phenylephrine because, theoretically, raises CO more.