Hemodynamic effects of cafedrine/theodrenaline on anesthesia-induced hypotension

Weitzel, Megan; Hammels, P.; Schorer, C.; Klingler, Hans-Christoph; Weyland, A.

doi:10.1007/s00101-018-0472-z

Cited by 11 publications

(13 citation statements)

References 13 publications

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“…Both study drugs exert inotropic and vasopressor effects, meaning the term inopressor best describes their mechanism of action and differentiates them from other sympathomimetic agents. Inopressors may be particularly suitable for treatment of hypotension occurring in association with propofol use as they counteract both cardiac impairment and vasodilation [1,6].…”

Section: Discussionmentioning

confidence: 99%

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Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

et al. 2020

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Background Sympathomimetic drugs are a therapeutic cornerstone for the management of hypotensive states like intraoperative hypotension (IOH). While cafedrine/theodrenaline (C/T) is widely used in Germany to restore blood pressure in patients with IOH, more research is required to compare its effectiveness with alternatives such as ephedrine (E) that are more commonly available internationally. Methods HYPOTENS (NCT02893241, DRKS00010740) was a prospective, national, multicenter, open-label, two-armed, non-interventional study that compared C/T with E for treatment of IOH. We describe a prospectively defined cohort of patients ≥50 years old with comorbidities undergoing general anesthesia induced with propofol and fentanyl. Primary objectives were to examine treatment precision, rapidity of onset and the ability to restore blood pressure without relevant increases in heart rate. Secondary endpoints were treatment satisfaction and the number of required additional boluses or other accompanying measures. Results A total of 1496 patients were included in the per protocol analysis. Overall, effective stabilization of blood pressure was achieved with both C/T and E. Post-hoc analysis showed that blood pressure increase from baseline was more pronounced with C/T. Fewer additional boluses or other accompanying measures were required in the C/T arm. The incidence of tachycardia was comparable between groups. Post-hoc analysis showed that E produced dose-dependent elevated heart rate values. By contrast, heart rate remained stable in patients treated with C/T. Physicians reported a higher level of treatment satisfaction with C/T, with a higher proportion of anesthetists rating treatment precision and rapidity of onset as good or very good when compared with E. Conclusion Neither drug was superior in restoring blood pressure levels; however, post-hoc analyses suggested that treatment is more goal-orientated and easier to control with C/T. Heart rate was shown to be more stable with C/T and fewer additional interventions were required to restore blood pressure, which could have contributed to the increased treatment satisfaction reported by anesthetists using C/T.

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Section: Discussionmentioning

confidence: 99%

“…E is more commonly used internationally and was approved for use in Germany only in 2013 [5]. Both agents stimulate alpha-and beta-adrenoceptors, making them particularly suited for the treatment of hypotension caused by both cardiac depression and vasodilatation [1,6].…”

Section: Brief Introduction To the Topicmentioning

confidence: 99%

Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

et al. 2020

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“…ephedrine is currently recommended instead of phenylephrine for patients with bradycardia). Unlike pure alpha agonists, differential blood pressure management is not needed with C/T, as cardiac index even increases with C/T treatment 17 . Heart rate values were shown to increase under ephedrine, while heart rate decreased transiently under C/T.…”

Section: Discussionmentioning

confidence: 99%

“…The α 1 and β 1 adrenoceptor activity of C/T produces a rapid and sustained increase in blood pressure without negative effects on umbilical cord arterial pH or Apgar scores 14,15 . In addition, maternal heart rate appears to remain stable during treatment with C/T 16,17 . In a recent retrospective study, the efficacy and safety of C/T was demonstrated to be comparable with ephedrine and phenylephrine for the treatment of hypotension in patients undergoing caesarean section 14 …”

Section: Introductionmentioning

confidence: 99%

“…14,15 In addition, maternal heart rate appears to remain stable during treatment with C/T. 16,17 In a recent retrospective study, the efficacy and safety of C/T was demonstrated to be comparable with ephedrine and phenylephrine for the treatment of hypotension in patients undergoing caesarean section. 14 Here, we report results comparing C/T with ephedrine in a prospectively defined cohort of parturients from the HYPOTENS study who received spinal anaesthesia for caesarean section.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of spinal anaesthesia-induced hypotension with cafedrine/theodrenaline versus ephedrine during caesarean section

Kranke

Geldner

Kienbaum

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND In Germany, hypotension induced by spinal anaesthesia is commonly treated with a combination of cafedrine hydrochloride (C, 200 mg) and theodrenaline hydrochloride (T, 10 mg) in 2 ml. We compared the effectiveness of C/T with ephedrine. OBJECTIVES The primary objectives were to assess the speed of onset and the ability to restore blood pressure without an increase in heart rate. Secondary objectives were to evaluate maternal/foetal outcomes and the number of required additional boluses or other additional measures. DESIGN HYPOTENS was a national, multicentre, prospective, open-label, two-armed, noninterventional study comparing C/T with ephedrine in two prospectively defined cohorts. This study relates to the cohort of patients receiving spinal anaesthesia for caesarean section. SETTING German hospitals using either C/T or ephedrine in their routine clinical practice. PATIENTS Women aged at least 18 years receiving spinal anaesthesia for caesarean section. INTERVENTIONS Bolus administration of C/T or ephedrine at the discretion of the attending anaesthesiologist. MAIN OUTCOME MEASURES Endpoints within 15 min after initial administration of C/T or ephedrine were area under the curve between the observed SBP and the minimum target SBP; and incidence of newly occurring heart rate of at least 100 beats min −1 . RESULTS Although effective blood pressure stabilisation was achieved with both treatments, this effect was faster and more pronounced with C/T ( P < 0.0001). The incidence of tachycardia and changes in heart rate were higher with ephedrine ( P < 0.01). Fewer additional boluses ( P < 0.01) were required with C/T. Although favourable neonatal outcomes were reported in both groups, base deficit and lactate values were greater with ephedrine ( P < 0.01). Physician satisfaction was higher with C/T. CONCLUSIONS After C/T, tachycardia was not a problem, providing an advantage over ephedrine. Fewer additional boluses were required with C/T, suggesting greater effectiveness. An increased base deficit with ephedrine suggests reduced oxygen supply or increased demands in foetal circulation. TRIALS REGISTRATION Clinicaltrials.gov: NCT02893241, German Clinical Trials Register: DRKS00010740.

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58/m mit Sepsis nach Perforation eines Sigmadivertikels

Dumps

Umrath

2019

Anaesthesist

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Hemodynamic effects of cafedrine/theodrenaline on anesthesia-induced hypotension

Abstract: In anesthesia-induced hypotension caf/theo effectively increased the mean arterial blood pressure by combined effects on preload, contractility, and afterload without altering cardiovascular efficiency.

Cited by 11 publications

References 13 publications

Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

Treatment of spinal anaesthesia-induced hypotension with cafedrine/theodrenaline versus ephedrine during caesarean section

58/m mit Sepsis nach Perforation eines Sigmadivertikels

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