Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients

Abstract

Background: How phenylephrine and ephedrine treatments affect global and regional haemodynamics is of major clinical relevance. Cerebral tissue oxygen saturation (Sct(O2) )-guided management may improve postoperative outcome. The physiological variables responsible for Sct(O2) changes induced by phenylephrine and ephedrine bolus treatment in anaesthetized patients need to be defined.

Methods: A randomized two-treatment cross-over trial was conducted: one bolus dose of phenylephrine (100-200 µg) and one bolus dose of ephedrine (5-20 mg) were given to 29 ASA I-III patients anaesthetized with propofol and remifentanil. , mean arterial pressure (MAP), cardiac output (CO), and other physiological variables were recorded before and after treatments. The associations of changes were analysed using linear-mixed models.

Results: The CO decreased significantly after phenylephrine treatment [▵CO = -2.1 (1.4) litre min(-1), P<0.001], but was preserved after ephedrine treatment [▵CO = 0.5 (1.4) litre min(-1), P>0.05]. The was significantly decreased after phenylephrine treatment [▵ = -3.2 (3.0)%, P<0.01] but preserved after ephedrine treatment [▵ = 0.04 (1.9)%, P>0.05]. CO was identified to have the most significant association with (P<0.001). After taking CO into consideration, the other physiological variables, including MAP, were not significantly associated with (P>0.05).

Conclusions: Associated with changes in CO, decreased after phenylephrine treatment, but remained unchanged after ephedrine treatment. The significant correlation between CO and implies a cause-effect relationship between global and regional haemodynamics.

Figures

Fig 1

Continuous MAP, CO, and recordings from two selected patients. (a–c) Recordings during phenylephrine treatment. (d–f) Recordings during ephedrine treatment. Both agents were given during the first treatment. Vertical arrows indicate the drug administration time.

Fig 2

Measurements of MAP, CO, and for every patient. (a–c) Measurements before (pre) and after (post) phenylephrine treatments. (d–f) Measurements before (pre) and after (post) ephedrine treatments.

Fig 3

Grouped MAP (a), CO (b), and (c) changes after the first and second phenylephrine (Phe) and the first and second ephedrine (Eph) treatments. The blue bars represent pretreatment values; the green striped bars represent post-treatment values. *P<0.01 (first treatment vs second treatment, unpaired Student's t-test).

Fig 4

Pearson's correlations between and global haemodynamics (MAP and CO) during the first and second phenylephrine (a and b) and the first and second ephedrine treatments (Tx) (c and d). ▵=post–pre.