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VASOACTIVE DRUGS IN CIRCULATORY SHOCK

Shock is the syndrome that results from failure of the cardiovascular system to
maintain adequate tissue perfusion.1 The initial priority is to maintain reasonable
hemodynamics while the etiology of shock is identified and its pathogenesis is addressed.
Hemodynamic therapy can be conceptualized in three broad categories: fluid
resuscitation, vasopressor therapy, and inotropic therapy. Fluid resuscitation is usually
the first step, but has been well described elsewhere,2 and will be considered only
peripherally; this review will focus on use of vasoactive agents for patients with shock.
When fluid administration fails to restore adequate arterial pressure and organ perfusion
in patients with shock, therapy with vasoactive agents should be initiated
.http://ajrccm.atsjournals.org/cgi/reprint/201006-0972CIv1

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Systemic Lidocaine Decreased the Perioperative Opioid Analgesic Requirements but Failed to Reduce Discharge Time After Ambulatory Surgery

Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge. Postoperative pain is the most common reason for delay in discharge and unplanned hospital admission after ambulatory surgery. 1–3 Because postoperative pain is to a large extent an inflammatory phenomenon, administration of systemic local anesthetics, which have inflammatory modulatory properties, 4 could significantly reduce pain and therefore allow more rapid discharge. 5 Lidocaine has an excellent safety record when administered by low-dose infusion. 5–7 However, whereas decreased hospital stay after inpatient surgery has been demonstrated, the effect of intraoperative and early postoperative lidocaine infusion on duration of stay after ambulatory surgery is not known. Although it see...