Important drugs

 Anaesthesiologists should always remember few facts about few important drugs without fail. Firstly, the drug of choice in surviving sepsis campaign is definitely Norepinephrine. Dobutamine is the drug of choice in post operative cardiac surgery cases. Renal dose of dopamine is a myth because it doesn't increase GFR and it's better avoided for fear of arrythmias. Phenylephrine is pure alpha 1 agonist and it lasts only for fifteen minutes. Avoid giving more than 2 microgram per kg per minute for fear of severe vasoconstriction and ischemia. Ephedrine lasts for one hour. But it's a tendency of causing foetal acidosis by decreasing uteroplacental perfusion due to its vasoconstriction. Ephedrine releases Norepinephrine from nerve terminals and produces its effects. When hypotension occurs after general anaesthesia, volatile  extra usage or after spinal anaesthesia, ephedrine is the drug of choice. But it can cause tachyphylaxis by its prolonged usage as the Norepinephrine stores get depleted. Among the two...amrinone and milrinone, milrinone is preferred as it doesn't cause thrombocytopenia. Milrinone increases the cyclic AMP by inhibiting phosphodiastrase and thus calcium entry increased and myocardial contractility too. When there's refractive hypotension in septic shock patients, try Vasopressin but it can cause diabetes insipidus and hyponatremia... Col Pradeep Pendyala