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Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia: a randomised controlled trial

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Abstract
BACKGROUND: Phenylephrine and norepinephrine are two vasopressors commonly used to counteract anaesthesia-induced hypotension. Their dissimilar working mechanisms may differentially affect the macro and microcirculation, and ultimately tissue oxygenation. OBJECTIVES: We investigated the differential effect of phenylephrine and norepinephrine on the heart rate (HR), stroke volume (SV), cardiac index (CI), cerebral tissue oxygenation (SctO(2)) and peripheral tissue oxygenation (SptO(2)), and rate-pressure product (RPP). DESIGN: A randomised controlled study. SETTING: Single-centre, University Medical Center Groningen, The Netherlands. PATIENTS: Sixty normovolaemic patients under balanced propofol/remifentanil anaesthesia. INTERVENTIONS: If the mean arterial pressure (MAP) dropped below 80% of the awake state value, phenylephrine (100 mu g + 0.5 mu g kg(-1) min(-1)) or norepinephrine (10 mu g + 0.05 mu g kg(-1) min(-1)) was administered in a randomised fashion. MAIN OUTCOME MEASURES: MAP, HR, SV, CI, SctO(2), SptO(2) and rate-pressure product (RPP) analysed from 30 s before drug administration until 240 s thereafter. RESULTS: Phenylephrine and norepinephrine caused an equivalent increase in MAP [Delta = 13 (8 to 22) and Delta = 13 (9 to 19) mmHg, respectively] and SV [Delta = 6 +/- 6 and Delta = 5 +/- 7 ml, respectively], combined with a significant equivalent decrease in HR (both Delta = -8 +/- 6 bpm), CI (both Delta = -0.2 +/- 0.3 l min(-1) m(-2)) and SctO(2) and an unchanged RPP (Delta = 345 +/- 876 and Delta = 537 +/- 1076 mmHg min(-1)). However, SptO(2) was slightly but statistically significantly (P < 0.05) decreased after norepinephrine [Delta = -3 (-6 to 0)%] but not after phenylephrine administration [Delta = 0 (-1 to 1)%]. In both groups, SptO(2) after vasopressor was still higher than the awake value. CONCLUSION: In normovolaemic patients under balanced propofol/remifentanil anaesthesia, phenylephrine and norepinephrine produced similar clinical effects when used to counteract anaesthesia-induced hypotension. After norepinephrine, a fall in peripheral tissue oxygenation was statistically significant, but its magnitude was not clinically relevant.
Keywords
NEAR-INFRARED SPECTROSCOPY, CEREBRAL-BLOOD-FLOW, CARDIAC-OUTPUT, ARTERIAL-PRESSURE, HEALTHY-SUBJECTS, VENOUS RETURN, SURGERY, REMIFENTANIL, SATURATION, PROPOFOL

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MLA
Poterman, Marieke, Jaap Jan Vos, Hugo EM Vereecke, et al. “Differential Effects of Phenylephrine and Norepinephrine on Peripheral Tissue Oxygenation During General Anaesthesia: a Randomised Controlled Trial.” EUROPEAN JOURNAL OF ANAESTHESIOLOGY 32.8 (2015): 571–580. Print.
APA
Poterman, M., Vos, J. J., Vereecke, H. E., Struys, M., Vanoverschelde, H., Scheeren, T. W., & Kalmar, A. (2015). Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia: a randomised controlled trial. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 32(8), 571–580.
Chicago author-date
Poterman, Marieke, Jaap Jan Vos, Hugo EM Vereecke, Michel Struys, Henk Vanoverschelde, Thomas WL Scheeren, and Alain Kalmar. 2015. “Differential Effects of Phenylephrine and Norepinephrine on Peripheral Tissue Oxygenation During General Anaesthesia: a Randomised Controlled Trial.” European Journal of Anaesthesiology 32 (8): 571–580.
Chicago author-date (all authors)
Poterman, Marieke, Jaap Jan Vos, Hugo EM Vereecke, Michel Struys, Henk Vanoverschelde, Thomas WL Scheeren, and Alain Kalmar. 2015. “Differential Effects of Phenylephrine and Norepinephrine on Peripheral Tissue Oxygenation During General Anaesthesia: a Randomised Controlled Trial.” European Journal of Anaesthesiology 32 (8): 571–580.
Vancouver
1.
Poterman M, Vos JJ, Vereecke HE, Struys M, Vanoverschelde H, Scheeren TW, et al. Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia: a randomised controlled trial. EUROPEAN JOURNAL OF ANAESTHESIOLOGY. 2015;32(8):571–80.
IEEE
[1]
M. Poterman et al., “Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia: a randomised controlled trial,” EUROPEAN JOURNAL OF ANAESTHESIOLOGY, vol. 32, no. 8, pp. 571–580, 2015.
@article{6924611,
  abstract     = {BACKGROUND: Phenylephrine and norepinephrine are two vasopressors commonly used to counteract anaesthesia-induced hypotension. Their dissimilar working mechanisms may differentially affect the macro and microcirculation, and ultimately tissue oxygenation.
OBJECTIVES: We investigated the differential effect of phenylephrine and norepinephrine on the heart rate (HR), stroke volume (SV), cardiac index (CI), cerebral tissue oxygenation (SctO(2)) and peripheral tissue oxygenation (SptO(2)), and rate-pressure product (RPP).
DESIGN: A randomised controlled study.
SETTING: Single-centre, University Medical Center Groningen, The Netherlands.
PATIENTS: Sixty normovolaemic patients under balanced propofol/remifentanil anaesthesia.
INTERVENTIONS: If the mean arterial pressure (MAP) dropped below 80% of the awake state value, phenylephrine (100 mu g + 0.5 mu g kg(-1) min(-1)) or norepinephrine (10 mu g + 0.05 mu g kg(-1) min(-1)) was administered in a randomised fashion.
MAIN OUTCOME MEASURES: MAP, HR, SV, CI, SctO(2), SptO(2) and rate-pressure product (RPP) analysed from 30 s before drug administration until 240 s thereafter.
RESULTS: Phenylephrine and norepinephrine caused an equivalent increase in MAP [Delta = 13 (8 to 22) and Delta = 13 (9 to 19) mmHg, respectively] and SV [Delta = 6 +/- 6 and Delta = 5 +/- 7 ml, respectively], combined with a significant equivalent decrease in HR (both Delta = -8 +/- 6 bpm), CI (both Delta = -0.2 +/- 0.3 l min(-1) m(-2)) and SctO(2) and an unchanged RPP (Delta = 345 +/- 876 and Delta = 537 +/- 1076 mmHg min(-1)). However, SptO(2) was slightly but statistically significantly (P < 0.05) decreased after norepinephrine [Delta = -3 (-6 to 0)%] but not after phenylephrine administration [Delta = 0 (-1 to 1)%]. In both groups, SptO(2) after vasopressor was still higher than the awake value.
CONCLUSION: In normovolaemic patients under balanced propofol/remifentanil anaesthesia, phenylephrine and norepinephrine produced similar clinical effects when used to counteract anaesthesia-induced hypotension. After norepinephrine, a fall in peripheral tissue oxygenation was statistically significant, but its magnitude was not clinically relevant.},
  author       = {Poterman, Marieke and Vos, Jaap Jan and Vereecke, Hugo EM and Struys, Michel and Vanoverschelde, Henk and Scheeren, Thomas WL and Kalmar, Alain},
  issn         = {0265-0215},
  journal      = {EUROPEAN JOURNAL OF ANAESTHESIOLOGY},
  keywords     = {NEAR-INFRARED SPECTROSCOPY,CEREBRAL-BLOOD-FLOW,CARDIAC-OUTPUT,ARTERIAL-PRESSURE,HEALTHY-SUBJECTS,VENOUS RETURN,SURGERY,REMIFENTANIL,SATURATION,PROPOFOL},
  language     = {eng},
  number       = {8},
  pages        = {571--580},
  title        = {Differential effects of phenylephrine and norepinephrine on peripheral tissue oxygenation during general anaesthesia: a randomised controlled trial},
  url          = {http://dx.doi.org/10.1097/EJA.0000000000000247},
  volume       = {32},
  year         = {2015},
}

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