Background anaesthetic agents do not influence the impact of arginine vasopressin on haemodynamic states and cerebral oxygenation during shoulder surgery in the beach chair position: a prospective, single-blind study

Eun-A Jang, Ji-A Song, Ji Youn Shin, Jae Joon Yoon, Kyung Yeon Yoo, Seongtae Jeong, Eun-A Jang, Ji-A Song, Ji Youn Shin, Jae Joon Yoon, Kyung Yeon Yoo, Seongtae Jeong

Abstract

Background: Administration of arginine vasopressin (AVP) is associated with reducing jugular venous (SjvO2) and regional cerebral (rScO2) oxygen saturation under propofol-remifentanil (P/R) anaesthesia. We determined whether background anaesthetics modulate the effect of AVP on cerebral oxygenation and haemodynamics.

Methods: We randomly allocated 60 adult patients scheduled for shoulder surgery in the beach chair position (BCP) into 4 groups, to receive either an intravenous bolus of saline (groups PR-S and SN-S) or 0.05 U/kg AVP (groups PR-AVP and SN-AVP) under P/R or sevoflurane-nitrous oxide (S/N) anaesthesia (n = 15 each). Haemodynamic variables, SjvO2 and rScO2 were measured.

Results: AVP significantly increased mean arterial blood pressure (MAP) and decreased rScO2 in either anaesthetic group. AVP also decreased SjvO2 in the P/R groups but not in the S/N groups. The AVP-treated groups showed higher MAP and cerebral desaturation (>20% rScO2 decrease from baseline), along with lower HR and rScO2 in the BCP than those in the saline-treated groups. In contrast, AVP did not affect SjvO2 values or the incidence of SjvO 2 < 50%. Baseline SjvO2 was lower and the magnitude of its reduction in the BCP was greater in the PR-AVP group than in the SN-AVP group, and the lowest SjvO2 values were 37 ± 6 and 57 ± 8%, respectively (P < 0.001).

Conclusions: The choice of anaesthetic regimen did not affect cerebral oxygenation or haemodynamics of AVP in the BCP. However, the negative effect of AVP on cerebral oxygenation should be considered, especially under P/R anaesthesia.

Trial registration: ClinicalTrials.gov identifier: NCT01687894 , registered on September 18, 2012.

Keywords: Anaesthetic; Arginine vasopressin; Beach chair position; Cerebral oxygenation; Haemodynamics.

Figures

Fig. 1
Fig. 1
CONSORT flow chart showing the flow of patients through the trial.PR-S and PR-AVP groups are given saline and arginine vasopressin (AVP) under propofol-remifentanil (PR) anesthesia, respectively. SN-S and SN-AVP groups are given saline and AVP under sevoflurane-nitrous oxide (SN) anesthesia, respectively
Fig. 2
Fig. 2
Effects of AVP on jugular venous oxygen saturation (SjvO2) after induction of anesthesia, before (presitting) and after the beach chair position. Data are means ± SD. BS represents the values after induction of anesthesia. Presitting values at time 0 were comparable between SN-S and SN-AVP groups, whereas they were significantly lower in PR-AVP than in PR-S groups (‡). *P < 0.05, compared with saline-given control groups; †P < 0.05, compared with AVP-treated groups by repeated measures two-way analysis of variance
Fig. 3
Fig. 3
Effects of AVP on regional cerebral tissue oxygen saturation (rSCO2) after induction of anesthesia, before (presitting) and after the beach chair position. BS represents the values after induction of anesthesia. Presitting values in supine position are shown at time 0. Data are presented as mean ± SD. The solid and dotted lines indicate the time period during which rSCO2 differed from their baseline values in control and AVP groups, respectively (P < 0.05). *P < 0.05, compared with respective control groups by repeated measures two-way analysis of variance
Fig. 4
Fig. 4
Effects of AVP on mean arterial pressure (MAP, upper) and heart rate (HR, lower) after induction of anesthesia, before (presitting) and after the beach chair position. BS represents the values after induction of anesthesia. Presitting values in supine position are shown at time 0. Data are presented as mean ± SD. *P < 0.05, compared with respective control groups by repeated measures two-way analysis of variance

References

    1. Buhre W, Weyland A, Buhre K, Kazmaier S, Mursch K, Schmidt M, et al. Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures. Br J Anaesth. 2000;84:354–357. doi: 10.1093/oxfordjournals.bja.a013439.
    1. Pohl A, Cullen DJ. Cerebral ischemia during shoulder surgery in the upright position: a case series. J Clin Anesth. 2005;17:463–469. doi: 10.1016/j.jclinane.2004.09.012.
    1. Drummond JC, Lee RR, Howell JP., Jr Focal cerebral ischemia after surgery in the "beach chair" position: the role of a congenital variation of circle of Willis anatomy. Anesth Analg. 2012;114:1301–1303. doi: 10.1213/ANE.0b013e31823aca46.
    1. Salazar D, Hazel A, Tauchen AJ, Sears BW, Marra G. Neurocognitive deficits and cerebral desaturation during shoulder arthroscopy with patient in beach-chair position: a review of the current literature. Am J Orthop. 2016;45:E63–E68.
    1. Buget MI, Atalar AC, Edipoglu IS, Sungur Z, Sivrikoz N, Karadeniz M, et al. Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position. Braz J Anesthesiol. 2016;66:470–474. doi: 10.1016/j.bjan.2015.09.004.
    1. Meng L, Cannesson M, Alexander BS, Yu Z, Kain ZN, Cerussi AE, et al. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth. 2011;107:209–217. doi: 10.1093/bja/aer150.
    1. Jeong H, Jeong S, Lim HJ, Lee J, Yoo KY. Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia. Anesthesiology. 2012;116:1233–1245. doi: 10.1097/ALN.0b013e31825154d2.
    1. Sørensen H, Secher NH, Siebenmann C, Nielsen HB, Kohl-Bareis M, Lundby C, et al. Cutaneous vasoconstriction affects near-infrared spectroscopy determined cerebral oxygen saturation during administration of norepinephrine. Anesthesiology. 2012;117:263–267. doi: 10.1097/ALN.0b013e3182605afe.
    1. Soeding PF, Hoy S, Hoy G, Evans M, Royse CF. Effect of phenylephrine on the haemodynamic state and cerebral oxygen saturation during anaesthesia in the upright position. Br J Anaesth. 2013;111:229–234. doi: 10.1093/bja/aet024.
    1. Morelli A, Tritapepe L, Rocco M, Conti G, Orecchioni A, De Gaetano A, et al. Terlipressin versus norepinephrine to counteract anesthesia-induced hypotension in patients treated with renin-angiotensin system inhibitors: effects on systemic and regional hemodynamics. Anesthesiology. 2005;102:12–19. doi: 10.1097/00000542-200501000-00006.
    1. Delmas A, Leone M, Rousseau S, Albanèse J, Martin C. Clinical review: vasopressin and terlipressin in septic shock patients. Crit Care. 2005;9:212–222. doi: 10.1186/cc2945.
    1. Wenzel V, Linder KH, Augenstein S, Prengel AW, Strohmenger HU. Vasopressin combined with epinephrine decreases cerebral perfusion compared with vasopressin alone during cardiopulmonary resuscitation in pigs. Stroke. 1998;29:1462–1467. doi: 10.1161/01.STR.29.7.1462.
    1. Dudkiewicz M, Proctor KG. Tissue oxygenation during management of cerebral perfusion pressure with phenylephrine or vasopressin. Crit Care med. 2008;36:2641–2650. doi: 10.1097/CCM.0b013e3181847af3.
    1. Cho SY, Kim SJ, Jeong CW, Jeong CY, Chung SS, Lee J, et al. Under general anesthesia arginine vasopressin prevents hypotension but impairs cerebral oxygenation during arthroscopic shoulder surgery in beach chair position. Anesth Analg. 2013;117:1436–1443. doi: 10.1213/ANE.0b013e3182a8fa97.
    1. Cho SY, Kim J, Park SH, Jeong S, Chung SS, Yoo KY. Vasopressin ameliorates hypotension induced by beach chair positioning in a dose-dependent manner in patients undergoing arthroscopic shoulder surgery under general anesthesia. Korean J Anesthesiol. 2015;68:232–240. doi: 10.4097/kjae.2015.68.3.232.
    1. Strebel SP, Kindler C, Bissonnette B, Tschalèr G, Deanovic D. The impact of systemic vasoconstrictors on the cerebral circulation of anesthetized patients. Anesthesiology. 1998;89:67–72. doi: 10.1097/00000542-199807000-00012.
    1. Bruins B, Kilbaugh TJ, Margulies SS, Friess SH. The anesthetic effects on vasopressor modulation of cerebral blood flow in an immature swine model. Anesth Analg. 2013;116:838–844. doi: 10.1213/ANE.0b013e3182860fe7.
    1. Matta BF, Heath KJ, Tipping K, Summors AC. Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology. 1999;91:677–680. doi: 10.1097/00000542-199909000-00019.
    1. Kaisti KK, Långsjö JW, Aalto S, Oikonen V, Sipila H, Teräs M, et al. Effects of sevoflurane, propofol, and adjunct nitrous oxide on regional cerebral blood flow, oxygen consumption, and blood volume in humans. Anesthesiology. 2003;99:603–13.
    1. Dashdorj N, Corrie K, Napolitano A, Petersen E, Mahajan RP, Auer DP. Effects of subanesthetic dose of nitrous oxide on cerebral blood flow and metabolism: a multimodal magnetic resonance imaging study in healthy volunteers. Anesthesiology. 2013;118:577–586. doi: 10.1097/ALN.0b013e3182800d58.
    1. Iwata M, Inoue S, Kawaguchi M, Takahama M, Tojo T, Taniguchi S, et al. Jugular bulb venous oxygen saturation during one-lung ventilation under sevoflurane- or propofol-based anesthesia for lung surgery. J Cardiothorac Vasc Anesth. 2008;22:71–6.
    1. Drummond JC, Hargens AR, Patel PM. Hydrostatic gradient is important: blood pressure should be corrected. APSF Newslett. 2009;24:6.
    1. Gopinath SP, Cormio M, Ziegler J, Raty S, Valadka A, Robertson CS. Intraoperative jugular desaturation during surgery for traumatic intracranial hematomas. Anesth Analg. 1996;83:1014–1021. doi: 10.1213/00000539-199611000-00020.
    1. Samra SK, Dy EA, Welch K, Dorje P, Zelenock GB, Stanley JC. Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology. 2000;93:964–970. doi: 10.1097/00000542-200010000-00015.
    1. Fernández N, Martínez MA, García-Villalón AL, Monge L, Diéguez G. Cerebral vasoconstriction produced by vasopressin in conscious goats: role of vasopressin V(1) and V(2) receptors and nitric oxide. Br J Pharmacol. 2001;132:1837–1844. doi: 10.1038/sj.bjp.0704034.
    1. Bein B, Cavus E, Dörges V, Stadlbauer KH, Tonner PH, Steinfath M, et al. Arginine vasopressin reduces cerebral oxygenation and cerebral blood volume during intact circulation in swine---a near infrared spectroscopy study. Eur J Anaesthesiol. 2005;22:62–66.
    1. Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology. 2000;93:947–953. doi: 10.1097/00000542-200010000-00012.
    1. Ogoh S, Sato K, Fisher JP, Seifert T, Overgaard M, Secher NH. The effect of phenylephrine on arterial and venous cerebral blood flow in healthy subjects. Clin Physiol Funct Imaging. 2011;31:445–451. doi: 10.1111/j.1475-097X.2011.01040.x.
    1. Davie SN, Grocott HP. Impact of extracranial contamination on regional cerebral oxygen saturation: a comparison of three cerebral oximetry technologies. Anesthesiology. 2012;116:834–840. doi: 10.1097/ALN.0b013e31824c00d7.
    1. Brabant SM, Eyraud D, Bertrand M, Coriat P. Refractory hypotension after induction of anesthesia in a patient chronically treated with angiotensin receptor antagonists. Anesth Analg. 1999;89:887–888.
    1. Trentman TL, Fassett SL, Thomas JK, Noble BN, Renfree KJ, Hattrup SJ. More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position. Can J Anaesth. 2011;58:993–1000. doi: 10.1007/s12630-011-9575-6.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit