Patrice Brassard1, Claudine Pelletier2, Mickaël Martin3, Nathalie Gagné4, Paul Poirier5, Philip N Ainslie6, Manon Caouette7, Jean S Bussières8. 1. Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada. Electronic address: patrice.brassard@kin.ulaval.ca. 2. Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada. 3. Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada. 4. Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada. 5. Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec, Canada. 6. Department of Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada. 7. Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada. 8. Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada; Department of Anesthesiology, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
Abstract
OBJECTIVE: Although utilization of vasopressors recently has been associated with reduced cerebral oxygenation, the influence of vasopressors on cerebral oxygenation during cardiopulmonary bypass in patients with diabetes is unknown. The aim of this study was to document the impact of norepinephrine and phenylephrine utilization on cerebral oxygenation in patients with and without diabetes during cardiopulmonary bypass. DESIGN: Prospective, clinical study. SETTING: Academic medical center. PARTICIPANTS: Fourteen patients with diabetes and 17 patients without diabetes undergoing cardiac surgery. INTERVENTIONS: During cardiopulmonary bypass, norepinephrine (diabetics n = 6; non-diabetics n = 8) or phenylephrine (diabetics n = 8; non-diabetics n = 9) was administered intravenously to maintain mean arterial pressure above 60 mmHg. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, venous temperature, arterial oxygenation, and frontal lobe oxygenation (monitored by near-infrared spectroscopy) were recorded before anesthesia induction (baseline) and continuously during cardiopulmonary bypass. Frontal lobe oxygenation was lowered to a greater extent in diabetics versus non-diabetics with administration of norepinephrine (-14±13 v 3±12%; p<0.05). There was also a trend towards a greater reduction in cerebral oxygenation in diabetics versus non-diabetics with administration of phenylephrine (-12±8 v -6±7%; p = 0.1) during cardiopulmonary bypass. CONCLUSIONS: Administration of norepinephrine to restore mean arterial pressure during cardiopulmonary bypass is associated with a reduction in frontal lobe oxygenation in diabetics but not in patients without diabetes. Administration of phenylephrine also were associated with a trend towards a greater reduction in frontal lobe oxygenation in diabetics. The clinical implications of these findings deserve future consideration.
OBJECTIVE: Although utilization of vasopressors recently has been associated with reduced cerebral oxygenation, the influence of vasopressors on cerebral oxygenation during cardiopulmonary bypass in patients with diabetes is unknown. The aim of this study was to document the impact of norepinephrine and phenylephrine utilization on cerebral oxygenation in patients with and without diabetes during cardiopulmonary bypass. DESIGN: Prospective, clinical study. SETTING: Academic medical center. PARTICIPANTS: Fourteen patients with diabetes and 17 patients without diabetes undergoing cardiac surgery. INTERVENTIONS: During cardiopulmonary bypass, norepinephrine (diabetics n = 6; non-diabetics n = 8) or phenylephrine (diabetics n = 8; non-diabetics n = 9) was administered intravenously to maintain mean arterial pressure above 60 mmHg. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, venous temperature, arterial oxygenation, and frontal lobe oxygenation (monitored by near-infrared spectroscopy) were recorded before anesthesia induction (baseline) and continuously during cardiopulmonary bypass. Frontal lobe oxygenation was lowered to a greater extent in diabetics versus non-diabetics with administration of norepinephrine (-14±13 v 3±12%; p<0.05). There was also a trend towards a greater reduction in cerebral oxygenation in diabetics versus non-diabetics with administration of phenylephrine (-12±8 v -6±7%; p = 0.1) during cardiopulmonary bypass. CONCLUSIONS: Administration of norepinephrine to restore mean arterial pressure during cardiopulmonary bypass is associated with a reduction in frontal lobe oxygenation in diabetics but not in patients without diabetes. Administration of phenylephrine also were associated with a trend towards a greater reduction in frontal lobe oxygenation in diabetics. The clinical implications of these findings deserve future consideration.
Authors: Ervin E Ševerdija; Nousjka P A Vranken; Steven Teerenstra; Yuri M Ganushchak; Patrick W Weerwind Journal: J Extra Corpor Technol Date: 2015-03
Authors: Anna Maria Bombardieri; Narinder P Singh; Lauren Yaeger; Umeshkumar Athiraman; Ban C H Tsui; Preet Mohinder Singh Journal: J Neurosurg Anesthesiol Date: 2021-06-10 Impact factor: 3.969