Which vasopressor is commonly used to maintain mean arterial pressure in neurogenic shock?

Which vasopressor is commonly used to maintain mean arterial pressure in neurogenic shock?

• A. Norepinephrine
• B. Phenylephrine
• C. Ephedrine
• D. Dopamine

Answer: (A)

In neurogenic shock, the loss of sympathetic tone causes widespread vasodilation and a drop in mean arterial pressure, so the goal is to raise systemic vascular resistance while supporting cardiac output. Norepinephrine is preferred because it provides strong alpha-1 mediated vasoconstriction to increase vascular tone and arterial pressure, helping restore MAP. At the same time, it has some beta-1 activity that supports heart rate and contractility, which is helpful since neurogenic shock often features bradycardia and reduced cardiac output. This combination makes norepinephrine the most reliable choice to maintain perfusion pressures in this setting. Phenylephrine, a pure alpha-1 agonist, can raise blood pressure but may cause reflex bradycardia and further reduce cardiac output. Ephedrine and dopamine are less predictable or carry higher risks of tachyarrhythmias or inconsistent effects in neurogenic shock.

In neurogenic shock, the loss of sympathetic tone causes widespread vasodilation and a drop in mean arterial pressure, so the goal is to raise systemic vascular resistance while supporting cardiac output. Norepinephrine is preferred because it provides strong alpha-1 mediated vasoconstriction to increase vascular tone and arterial pressure, helping restore MAP. At the same time, it has some beta-1 activity that supports heart rate and contractility, which is helpful since neurogenic shock often features bradycardia and reduced cardiac output. This combination makes norepinephrine the most reliable choice to maintain perfusion pressures in this setting.

Phenylephrine, a pure alpha-1 agonist, can raise blood pressure but may cause reflex bradycardia and further reduce cardiac output. Ephedrine and dopamine are less predictable or carry higher risks of tachyarrhythmias or inconsistent effects in neurogenic shock.