Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery
Abstract Cardiopulmonary bypass (CPB) in cardiac surgery is associated with a high risk of postoperative neurological complications. Perioperative use of vasopressors is common to counteract arterial hypotension in this setting. However, use of α‐agonist vasopressors has been associated with cerebra...
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Wiley
2025-06-01
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| Series: | Experimental Physiology |
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| Online Access: | https://doi.org/10.1113/EP092387 |
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| author | Edouard Marques Etienne J. Couture Jean S. Bussières Stephan Langevin Paul Poirier Pierre Voisine Manon Caouette Patrice Brassard |
| author_facet | Edouard Marques Etienne J. Couture Jean S. Bussières Stephan Langevin Paul Poirier Pierre Voisine Manon Caouette Patrice Brassard |
| author_sort | Edouard Marques |
| collection | DOAJ |
| description | Abstract Cardiopulmonary bypass (CPB) in cardiac surgery is associated with a high risk of postoperative neurological complications. Perioperative use of vasopressors is common to counteract arterial hypotension in this setting. However, use of α‐agonist vasopressors has been associated with cerebral desaturations. Given that reductions in cerebral oxygen saturation (ScO2) can increase postoperative neurological dysfunction, we aimed to investigate the impact of noradrenaline (NA) and phenylephrine (PE) on ScO2 during the CPB period of a cardiac surgery in 36 patients scheduled for an elective cardiac surgery. Patients were randomized to the intra‐operative use of either NA or PE. During CPB, mean arterial pressure (MAP) was elevated pharmacologically to predefined thresholds of 60 and 80 mmHg, while CPB flow was kept constant. The ScO2 values were recorded for 5 min per MAP threshold. The MAP increased adequately between thresholds of 60 and 80 mmHg (NA, 59 ± 3 vs. 81 ± 3 mmHg and PE, 61 ± 4 vs. 81 ± 3 mmHg; P ˂ 0.01). The ScO2 decreased between pressure thresholds of 60 and 80 mmHg (NA, 70 ± 11 vs. 69 ± 11 mmHg and PE, 64 ± 11 vs. 63 ± 11 mmHg; P ˂ 0.01). Reduction in ScO2 did not differ between vasopressors. The mean relative decrease in ScO2 across groups was 2.0% (95% confidence interval: 0.6 to 2.1). Elevation in MAP mediated solely by vasopressors induces significant decreases in ScO2 during cardiac surgery under CPB. However, their impact on ScO2 remains clinically non‐significant according to current guidelines. |
| format | Article |
| id | doaj-art-d19de4508cd2496d8a44833c7332ff10 |
| institution | Kabale University |
| issn | 0958-0670 1469-445X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Experimental Physiology |
| spelling | doaj-art-d19de4508cd2496d8a44833c7332ff102025-08-20T03:35:41ZengWileyExperimental Physiology0958-06701469-445X2025-06-01110679880810.1113/EP092387Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgeryEdouard Marques0Etienne J. Couture1Jean S. Bussières2Stephan Langevin3Paul Poirier4Pierre Voisine5Manon Caouette6Patrice Brassard7Institut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaInstitut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaInstitut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaInstitut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaInstitut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaInstitut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaInstitut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaInstitut Universitaire de Cardiologie et de Pneumologie de Québec–Université Laval Québec CanadaAbstract Cardiopulmonary bypass (CPB) in cardiac surgery is associated with a high risk of postoperative neurological complications. Perioperative use of vasopressors is common to counteract arterial hypotension in this setting. However, use of α‐agonist vasopressors has been associated with cerebral desaturations. Given that reductions in cerebral oxygen saturation (ScO2) can increase postoperative neurological dysfunction, we aimed to investigate the impact of noradrenaline (NA) and phenylephrine (PE) on ScO2 during the CPB period of a cardiac surgery in 36 patients scheduled for an elective cardiac surgery. Patients were randomized to the intra‐operative use of either NA or PE. During CPB, mean arterial pressure (MAP) was elevated pharmacologically to predefined thresholds of 60 and 80 mmHg, while CPB flow was kept constant. The ScO2 values were recorded for 5 min per MAP threshold. The MAP increased adequately between thresholds of 60 and 80 mmHg (NA, 59 ± 3 vs. 81 ± 3 mmHg and PE, 61 ± 4 vs. 81 ± 3 mmHg; P ˂ 0.01). The ScO2 decreased between pressure thresholds of 60 and 80 mmHg (NA, 70 ± 11 vs. 69 ± 11 mmHg and PE, 64 ± 11 vs. 63 ± 11 mmHg; P ˂ 0.01). Reduction in ScO2 did not differ between vasopressors. The mean relative decrease in ScO2 across groups was 2.0% (95% confidence interval: 0.6 to 2.1). Elevation in MAP mediated solely by vasopressors induces significant decreases in ScO2 during cardiac surgery under CPB. However, their impact on ScO2 remains clinically non‐significant according to current guidelines.https://doi.org/10.1113/EP092387cardiac surgerycerebral oximetrynoradrenalinephenylephrinevasopressor |
| spellingShingle | Edouard Marques Etienne J. Couture Jean S. Bussières Stephan Langevin Paul Poirier Pierre Voisine Manon Caouette Patrice Brassard Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery Experimental Physiology cardiac surgery cerebral oximetry noradrenaline phenylephrine vasopressor |
| title | Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery |
| title_full | Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery |
| title_fullStr | Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery |
| title_full_unstemmed | Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery |
| title_short | Effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery |
| title_sort | effects of noradrenaline and phenylephrine on cerebral oxygen saturation during cardiopulmonary bypass in cardiac surgery |
| topic | cardiac surgery cerebral oximetry noradrenaline phenylephrine vasopressor |
| url | https://doi.org/10.1113/EP092387 |
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