Norepinephrine reduces arterial compliance less than phenylephrine when treating general anesthesia‐induced arterial hypotension

Vallée, Fabrice; Passouant, O.; Gall, Arthur Le; Joachim, Jona; Matéo, Joaquim; Mebazaa, Alexandre; Gayat, Étienne

doi:10.1111/aas.12905

Cited by 39 publications

(36 citation statements)

References 45 publications

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“…The anesthetist in charge of the patient could change the anesthetic drug concentrations at any time, though doing so excluded that patient from the final analysis. According to our standard care protocol for neuroradiological procedure, intra‐operative episodes of anesthesia‐induced hypotension without evidence of hypovolemia (mean arterial pressure (MAP) <65 mm Hg or <80% baseline) were treated by a norepinephrine bolus of 10 µg …”

Section: Methodsmentioning

confidence: 99%

Impact of hypotension on cerebral perfusion during general anesthesia induction: A prospective observational study in adults

Chaix

Manquat

Liu

et al. 2020

Acta Anaesthesiol Scand

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Introduction During anesthesia, decreases in mean arterial pressure (MAP) are common but the impact on possible cerebral hypoperfusion remains a matter of debate. We evaluated cerebral perfusion in patients with or without cardiovascular comorbidities (Hi‐risk vs Lo‐risk) during induction of general anesthesia and during hypotensive episodes. Methods Patients scheduled for neuroradiology procedure using standardized target‐controlled Propofol‐Remifentanil infusion were prospectively included. Monitoring included Transcranial Doppler (TCD) measuring mean blood velocity of the middle cerebral artery (Vm), Bispectral Index with burst suppression ratio (SR) and cerebral Near‐Infrared Spectroscopy (NIRS). Hypotensive episodes were treated with a 10 µg bolus of Norepinephrine. Results Eighty‐one patients were included, 37 Hi‐risk and 44 Lo‐risk. During induction of anesthesia, MAP and Vm decreased in all patients, with greater changes observed in Hi‐risk patients compared to Lo‐risk patients (−34 [38‐29]% vs −17 [25‐8]%, P < .001 and −39 [45‐29]% vs −28 [34‐19]%, P < .01 respectively). In Hi‐risk patients, the MAP‐decrease correlated with the Vm‐decrease (r = .48, P < .01), and was associated with more frequent occurrences of SR (21 vs 5 patients, P < .01 for Hi‐risk vs Lo‐risk). For the MAP‐increase induced by norepinephrine, the Vm‐increase was greater in Hi‐risk than in Lo‐risk patients (+15 [8‐21]% vs +4 [1‐11]%, P < .01). During induction and norepinephrine boluses, NIRS values did not follow acute changes of Vm. Conclusion Our results showed that Hi‐risk patients had a higher decrease in MAP and Vm, and a higher occurrence of SR during induction of anesthesia than Lo‐risk patients. Correction of MAP with norepinephrine increased Vm mainly in Hi‐rik patients.

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Section: Methodsmentioning

confidence: 99%

Impact of hypotension on cerebral perfusion during general anesthesia induction: A prospective observational study in adults

Chaix

Manquat

Liu

et al. 2020

Acta Anaesthesiol Scand

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“…Risk factors include chronic hypertension and advanced age ( 7 ). An effective way to treat intraoperative hypotension is intravascular administration of vasopressor (pressor agent) delivered by bolus or continuous infusion ( 2 , 4 ). Vasopressors act by reversing sympathetic block in circulation.…”

Section: Introductionmentioning

confidence: 99%

“…Vasopressors might cause adverse effects such as increased arterial stiffness, increased myocardial work, decreased stroke volume, and decreased arterial compliance ( 10 ). Ephedrine is considered a vasopressor of choice, especially in obstetric surgery ( 2 , 11 - 13 ). However, ephedrine has some several adverse effects; it causes arrhythmia ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, ephedrine has some several adverse effects; it causes arrhythmia ( 10 ). Intraoperative hypotension is usually attributted to anesthetic agents causing reduction of cardiac output and systemic vascular resistance by a variety of mechanisms ( 2 , 7 ). Spinal anesthesia induces hypotension by reduction of cardiac preload ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Ephedrine vs. Norepinephrine in Treating Anesthesia-Induced Hypotension in Hypertensive Patients: Randomized Double-Blinded Study

et al. 2018

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BackgroundHypotension is a common problem in general anesthesia. Maintaining the mean arterial pressure by choosing a vasopressor with minimal complications is still discussed in various surgeries.ObjectivesThe aim of this study is comparison of ephedrine versus norepinephrine in treating anesthesia-induced hypotension in hypertensive patients in spinal surgery in a randomized double-blinded study.MethodsThis randomized, double-blinded study was approved by Iran University of Medical Sciences, operating room of medical center. Data collection was completed between Jan to Dec 2017. Inclusion criteria included age between 20 and 75 years, history of high blood pressure (a patient who has been treated for maximum 5 years with a anti hypertensive medication), and patients under general anesthesia in spinal surgery. The exclusion criteria were based on American Society of Anesthesiologists physical status of 3 or higher, history of arrhythmia, heart valve disease, cerebrovascular disease, kidney failure, beta-blocker use and diabetes, as well as intra operative massive blood loss. After initiation of anesthesia, when the pressure reaches less than 60, the patient entered the protocol and simultaneously administration of 5 mL/kg serum crystalloid and vasopressor. Patients were randomized to the ephedrine group (n = 28) who received 5 mg ephedrine intravenous (i.v.) or norepinephrine Group (n = 28) who received 10 µg (i.v.) bolus norepinephrine at anesthesia-induced hypotension. The administration of 5 mL/kg serum crystalloid and vasopressor was simultaneous. If the mean arterial pressure (MAP) had not reached 60 mmHg, the same dose should be repeated at a maximum of three or more times at five-minute intervals in the ephedrine group and at two minutes intervals in the norepinephrine group. All parameters were collected before and at the end of administration anesthesia drug and during episodes of hypotension. Hemodynamic variables, frequency of hypotension, and total number of vasopressors doses during anesthesia were recorded and analyzed.ResultsThe mean number of hypotension times, the number of vasopressors doses in the first hypotension, the total number of doses consumed during the anesthesia, and heart rate at the end of anesthesia were lower in the norepinephrine group (P) respectively. MAP, 5 minutes after the first episode of hypotension and MAP at the end of anesthesia were higher in norepinephrine group.ConclusionsNorepinephrine is more effective than ephedrine in maintenance of MAP in hypertensive patients undergoing spinal surgery under general anesthesia.

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“…7 Indeed, it is also known that using phenylephrine can lead to a CO decrease, compared to norepinephrine. 8,9 In a retrospective study, patients treated with phenylephrine for DCI after SAH were less responder to IH treatment in terms of clinical improvement and had more delayed infarct on imaging, compared to patients treated with norepinephrine. 10 In this direction, interesting results showed an increase in CBF secondary to an increase of CO in patients with DCI, independently of MAP.…”

mentioning

confidence: 99%

Commentary: Posterior Reversible Encephalopathy Syndrome as a Complication of Induced Hypertension in Subarachnoid Hemorrhage: A Case-Control Study

Dépret

Coutrot

2018

Neurosurg.

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Norepinephrine reduces arterial compliance less than phenylephrine when treating general anesthesia‐induced arterial hypotension

Abstract: This study suggests that 5 μg of NA administered as a bolus in a peripheral venous line could treat general anesthesia-induced arterial hypotension with a smaller decrease in SV and arterial compliance when compared to PE.

Cited by 39 publications

References 45 publications

Impact of hypotension on cerebral perfusion during general anesthesia induction: A prospective observational study in adults

Impact of hypotension on cerebral perfusion during general anesthesia induction: A prospective observational study in adults

Comparison of Ephedrine vs. Norepinephrine in Treating Anesthesia-Induced Hypotension in Hypertensive Patients: Randomized Double-Blinded Study

Commentary: Posterior Reversible Encephalopathy Syndrome as a Complication of Induced Hypertension in Subarachnoid Hemorrhage: A Case-Control Study

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