Q: During the management of the deceased organ donor, a hypertensive autonomic storm may become a hurdle due to massive sympathetic discharge following brain death. Which drug can best counteract this effect?
Answer: Esmolol
Usual sequelae following brain death is an initial hypertensive crisis followed by hypotension. This hypertensive crisis and tachycardia are frequently referred to as an autonomic storm. This happens due to massive sympathetic discharge after brain death. Esmolol, a beta-adrenergic antagonist, being a short-acting agent is best to counteract this effect.
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References
1. Kotloff RM, Blosser S, Fulda GJ, et al. Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med 2015; 43:1291.
2. Audibert G, Charpentier C, Seguin-Devaux C, et al. Improvement of donor myocardial function after treatment of autonomic storm during brain death. Transplantation 2006; 82:1031.
3. Ferrera R, Hadour G, Tamion F, et al. Brain death provokes very acute alteration in myocardial morphology detected by echocardiography: preventive effect of beta-blockers. Transpl Int 2011; 24:300.
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