Vasopressors and Inotropes in Recovery

haemodynamic inotrope pacu recovery vasopressor Feb 09, 2026

Post-operative hypotension is a frequent challenge in the recovery period after non-cardiac surgery and can contribute to organ dysfunction and poor outcomes. Vasopressors and inotropes are vasoactive agents used to support blood pressure and cardiac output when conventional measures such as fluid therapy are insufficient. Understanding when and why these drugs are used helps perioperative nurses anticipate patient needs and support safe care transitions.

At a basic level, vasopressors constrict blood vessels to increase systemic vascular resistance and raise mean arterial pressure, while inotropes enhance the strength of cardiac contractions to improve cardiac output. These mechanisms help maintain perfusion to vital organs in the face of persistent hypotension that may not respond to fluid alone.

Key points

  • Enhancing perfusion pressure supports vital organ function when hypotension persists.
    • Vasopressors are often used when vasodilation is a dominant cause of low blood pressure.
    • Inotropes are considered when cardiac contractility is poor or cardiac output is inadequate.
    • Common agents include noradrenaline (most commonly used vasopressor) and fluids as first-line support.
    • The choice and combination of drugs are tailored to the patient’s physiology and response.

Practical implications

In the post-anaesthesia care unit (PACU), patients with systolic blood pressure below 90 mmHg may receive fluids, vasopressors, inotropes, or a combination depending on clinical judgement and response to initial therapy. Evidence suggests that many patients remain hypotensive or eventually require vasopressor infusions within 24 hours after PACU discharge.

Clinical insight

Recovery nurses play a vital role in early recognition of hypotension in PACU and escalation of care. Knowing the purpose and effects of these agents helps with clear communication during handovers and supports vigilant monitoring for therapeutic effectiveness and potential side effects.

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References
Douglas N, Leslie K, Darvall JN. (2023). Vasopressors to treat postoperative hypotension after adult noncardiac, non-obstetric surgery: a systematic review. Br J Anaesth.
Douglas N, Gilbert S, Ong J et al. (2025). Treatment of and outcomes from hypotension in the post-anaesthesia care unit: A single-centre retrospective cohort study. Anaesth Intensive Care.

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