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Effects of dobutamine and phenylephrine on cerebral perfusion in patients undergoing cerebral bypass surgery: a randomised crossover trial


Akkermans, Annemarie; van Waes, Judith A R; van Doormaal, Tristan P C; de Waal, Eric E C; Rinkel, Gabriël J E; van der Zwan, Albert; Kalkman, Cor J; van Klei, Wilton A (2020). Effects of dobutamine and phenylephrine on cerebral perfusion in patients undergoing cerebral bypass surgery: a randomised crossover trial. British Journal of Anaesthesia, 125(4):539-547.

Abstract

BACKGROUND

Patients undergoing cerebral bypass surgery are prone to cerebral hypoperfusion. Currently, arterial blood pressure is often increased with vasopressors to prevent cerebral ischaemia. However, this might cause vasoconstriction of the graft and cerebral vasculature and decrease perfusion. We hypothesised that cardiac output, rather than arterial blood pressure, is essential for adequate perfusion and aimed to determine whether dobutamine administration resulted in greater graft perfusion than phenylephrine administration.

METHODS

This randomised crossover study included 10 adult patients undergoing cerebral bypass surgery. Intraoperatively, patients randomly and sequentially received dobutamine to increase cardiac index or phenylephrine to increase mean arterial pressure (MAP). An increase of >10% in cardiac index or >10% in MAP was targeted, respectively. Before both interventions, a reference phase was implemented. The primary outcome was the absolute difference in graft flow between the reference and intervention phase. We compared the absolute flow difference between each intervention and constructed a random-effect linear regression model to explore treatment and carry-over effects.

RESULTS

Graft flow increased with a median of 4.1 (inter-quartile range [IQR], 1.7-12.0] ml min$^{-1}$) after dobutamine administration and 3.6 [IQR, 1.3-7.8] ml min$^{-1}$ after phenylephrine administration (difference -0.6 ml min$^{-1}$; 95% confidence interval [CI], -14.5 to 5.3; P=0.441). There was no treatment effect (0.9 ml min$^{-1}$; 95% CI, 0.0-20.1; P=0.944) and no carry-over effect.

CONCLUSIONS

Both dobutamine and phenylephrine increased graft flow during cerebral bypass surgery, without a preference for one method over the other.

CLINICAL TRIAL REGISTRATION

Netherlands Trial Register, NL7077 (https://www.trialregister.nl/trial/7077).

Abstract

BACKGROUND

Patients undergoing cerebral bypass surgery are prone to cerebral hypoperfusion. Currently, arterial blood pressure is often increased with vasopressors to prevent cerebral ischaemia. However, this might cause vasoconstriction of the graft and cerebral vasculature and decrease perfusion. We hypothesised that cardiac output, rather than arterial blood pressure, is essential for adequate perfusion and aimed to determine whether dobutamine administration resulted in greater graft perfusion than phenylephrine administration.

METHODS

This randomised crossover study included 10 adult patients undergoing cerebral bypass surgery. Intraoperatively, patients randomly and sequentially received dobutamine to increase cardiac index or phenylephrine to increase mean arterial pressure (MAP). An increase of >10% in cardiac index or >10% in MAP was targeted, respectively. Before both interventions, a reference phase was implemented. The primary outcome was the absolute difference in graft flow between the reference and intervention phase. We compared the absolute flow difference between each intervention and constructed a random-effect linear regression model to explore treatment and carry-over effects.

RESULTS

Graft flow increased with a median of 4.1 (inter-quartile range [IQR], 1.7-12.0] ml min$^{-1}$) after dobutamine administration and 3.6 [IQR, 1.3-7.8] ml min$^{-1}$ after phenylephrine administration (difference -0.6 ml min$^{-1}$; 95% confidence interval [CI], -14.5 to 5.3; P=0.441). There was no treatment effect (0.9 ml min$^{-1}$; 95% CI, 0.0-20.1; P=0.944) and no carry-over effect.

CONCLUSIONS

Both dobutamine and phenylephrine increased graft flow during cerebral bypass surgery, without a preference for one method over the other.

CLINICAL TRIAL REGISTRATION

Netherlands Trial Register, NL7077 (https://www.trialregister.nl/trial/7077).

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Anesthesiology and Pain Medicine
Language:English
Date:October 2020
Deposited On:07 Aug 2020 09:28
Last Modified:21 Sep 2020 01:07
Publisher:Elsevier
ISSN:0007-0912
OA Status:Hybrid
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.bja.2020.05.040
PubMed ID:32718724

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