Preload dependency determines the effects of phenylephrine on cardiac output in anaesthetised patients: A prospective observational study.
Eur J Anaesthesiol
; 33(9): 638-44, 2016 09.
Article
en En
| MEDLINE
| ID: mdl-27164015
ABSTRACT
BACKGROUND:
Although phenylephrine is widely used in the operating room to control arterial pressure, its haemodynamic effects remain controversial.OBJECTIVE:
We hypothesised that the effect of phenylephrine on cardiac output is affected by preload dependency.DESIGN:
A prospective observational study.SETTING:
Single-centre, University Hospital of Caen, France. PATIENTS Fifty ventilated patients undergoing surgery were studied during hypotension before and after administration of phenylephrine. MAIN OUTCOMEMEASURES:
Cardiac index (CI), stroke volume (SV), corrected flow time, mean arterial pressure, pulse pressure variations (PPV) and systemic vascular resistance index were used to assess effects of changes in preload dependency.RESULTS:
Twenty seven (54%) patients were included in the preload-dependent group (PPVâ≥â13%) and 23 (46%) in the preload-independent group (PPVâ<â13%) before administration of phenylephrine. For the whole cohort, phenylephrine increased mean arterial pressure [58 (±8)âmmHg vs. 79 (±13)âmmHg; Pâ<â0.0001] and calculated systemic vascular resistance index [2010 (1338; 2481)âdyn sâcmâm vs. 2989 (2155; 3870)âdyn sâcmâm; Pâ<â0.0001]. However, CI and SV decreased in the preload-independent group [2.3 (1.9; 3.7)âlâminâm vs. 1.8 (1.5; 2.7)âl minâm; Pâ<â0.0001 and 65 (44; 81)âml vs. 56 (39; 66) ml; Pâ<â0.0001 for both] but not in the preload-dependent group [respectively 2.1 (1.8; 3.5)âlâminâm vs. 2.1 (1.8; 3.3)âlâminâm; Pâ=â0.168 and 49 (41; 67)âml vs. 53 (41; 69)âml; Pâ=â0.191]. Corrected flow time increased [294 (47)âms vs. 306 (56)âms; Pâ=â0.031], and PPV decreased [17 (15; 19) % vs.12 (14; 16) %; Pâ<â0.0003] only in the PPV at least 13% group.CONCLUSION:
The effects of phenylephrine on CI and SV depend on preload. CI and SV decreased in preload-independent patients through increase in afterload, but were unchanged in those preload-dependent through increased venous return.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Fenilefrina
/
Vasoconstrictores
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Gasto Cardíaco
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Anestesia General
Tipo de estudio:
Etiology_studies
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Observational_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2016
Tipo del documento:
Article