Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

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• 作者：Ove Andreas Hagen ; MD^* ; ^{uxovha@ous-hf.no" class="auth_mail" title="E-mail the corresponding author} ; Lars Ø ; ivind Hø ; iseth ; MD ; PhD^* ; ^&dagger ; ; André ; Roslin ; MD^* ; Svein Aslak Landsverk ; MD ; PhD^* ; Per Reidar Woldbaek ; MD ; PhD^&Dagger ; ; Are Hugo Pripp ; PhD^§ ; ; Rolf Hanoa ; MD ; PhD^ǁ ; ^¶ ; ; Knut Arvid Kirkebø ; en ; MD ; PhD^* ; ^&dagger ;
• 关键词：oximetry ; norepinephrine ; cardiopulmonary bypass
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：30
• 期：2
• 页码：291-296
• 全文大小：398 K

文摘

Norepinephrine is used to increase mean arterial pressure during cardiopulmonary bypass. However, it has been suggested that norepinephrine could constrict cerebral arteries, reducing cerebral blood flow. The aim of this study, therefore, was to explore whether there was an association between doses of norepinephrine to maintain mean arterial pressure at ≈80 mmHg during cardiopulmonary bypass and cerebral oxygen saturation measured using near-infrared spectroscopy.

Design

Observational study.

Setting

University hospital.

Participants

Patients undergoing cardiac surgery (n = 45) using cardiopulmonary bypass.

Interventions

Norepinephrine was administered to maintain mean arterial pressure ≈80 mmHg during cardiopulmonary bypass.

Measurements and Main Results

From initiation of cardiopulmonary bypass to removal of the aortic cross-clamp, norepinephrine dose, mean arterial pressure, partial pressure of arterial carbon dioxide, partial pressure of arterial oxygen, hemoglobin, and pump flow values were averaged over 1 minute, giving a total of 3,460 data points entered as covariates in a linear mixed model for repeated measurements, with cerebral oxygen saturation measured using near-infrared spectroscopy as outcome. There was no statistically significant association between norepinephrine dose to maintain mean arterial pressure and cerebral oxygen saturation (p = 0.46) in this model.

Conclusions

Administration of norepinephrine to maintain mean arterial pressure ≈80 mmHg during cardiopulmonary bypass was not associated with statistically significant changes in cerebral oxygen saturation. These results indicated that norepinephrine could be used to increase mean arterial pressure during cardiopulmonary bypass without reducing cerebral oxygen saturation.