title: Altered pharmacological effects of adrenergic agonists during hypothermia.
abstract: Rewarming from accidental hypothermia is often complicated by hypothermia-induced cardiac dysfunction, calling for immediate pharmacologic intervention. Studies show that although cardiac pharmacologic support is applied when rewarming these patients, a lack of updated treatment recommendations exist. Mainly due to lack of clinical and experimental data, neither of the international guidelines includes information about pharmacologic cardiac support at temperatures below 30 °C. However, core temperature of accidental hypothermia patients is often reduced below 30 °C. Few human studies exploring effects of adrenergic drugs during hypothermia have been published, and therefore prevailing information is collected from pre-clinical studies. The most prominent finding in these studies is an apparent depressive effect of adrenaline on cardiac function when used in doses which elevate cardiac output during normothermia. Also noradrenaline and isoprenaline largely lacked positive cardiac effects during hypothermia, while dopamine is a more promising drug for supporting cardiac function during rewarming. Data and information from these studies are in support of the prevailing notion; not to use adrenergic drugs at core temperatures below 30 °C.
authors.affiliation: Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway. erik.sveberg.dietrichs@uit.no.|Department of Research and Education, Norwegian Air Ambulance Foundation, 1441, Drøbak, Norway. erik.sveberg.dietrichs@uit.no.
authors.forename: Erik Sveberg
authors.initials: ES
authors.lastname: Dietrichs
authors.affiliation: Experimental and Clinical Pharmacology, Department of medical biology, UiT, The Arctic University of Norway, 9037, Tromsø, Norway.
authors.forename: Georg
authors.initials: G
authors.lastname: Sager
authors.affiliation: Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT, The Arctic University of Norway, 9037, Tromsø, Norway.|Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, 9038, Tromsø, Norway.
authors.forename: Torkjel
authors.initials: T
authors.lastname: Tveita
mesh_terms: D000322:Adrenergic Agonists / Q000627:therapeutic use*; D001831:Body Temperature / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology / Q000628:therapy*; D017694:Rewarming / Q000379:methods*
chemical_list: D000322:Adrenergic Agonists
keywords: Adrenergic drugs; Cardiovascular dysfunction; Cooling; Hypothermia; Inotropic; Pharmacology; Rearming shock; Rewarming; Vasopressor