Inotropic drugs in acute circulatory failure

The use of inotropic drugs in patients requiring acute circulatory support is reviewed. A knowledge of their various peripheral effects is essential if the appropriate drug is to be used. The place or pressor amines, digitalis, salbutamol and glucagon in the treatment of patients with poor tissue perfusion is limited. Of the catecholamines, adrenaline causes excessive renal vasoconstriction and peripheral gangrene, noradrenaline increase myocardial work and diminishes peripheral perfusion and isoprenaline distributes blood away from the vital organs, namely: brain, kidneys, heart and mesentery. Dopamine is a useful agent as it enhances renal blood flow in low doses and is not excessively chronotropic. Dobutamine has not yet been shown to have significant advantages over other inotropes and requires further examination.