Skip to main content

Phenylephrine,treating hypotension and injure Brain







The importance of arterial pressure management in patients undergoing anesthesia has been substantiated by the significant relationship between intraoperative hypotension and postoperative neurocognitive impairment.

Despite the fact that arterial pressure monitoring is a standard practice, consensus in terms of when and how to treat intraoperative hypotension is still lacking. Among all options, phenylephrine and ephedrine belong to the set of typical sympathomimetic agents routinely chosen to increase arterial pressure.

 However, little is known about the impacts of these agents on cerebral oxygenation and the relationship between global and regional haemodynamics. If treating hypotension is an attempt to avoid organ ischaemia and hypoxia, we are actually achieving the opposite result (decreased cerebral oxygenation) by administering phenylephrine, as demonstrated in study( published in BJA November Issue) using a quantitative NIRS device and in previous studies using a trend NIRS device.

Another study also demonstrated the negative impact of norepinephrine infusion on cerebral oxygenation. Thus, the routine and indiscriminate use of vasopressors might be less beneficial than previously thought.

  1. Nissen P, Brassard P, Jørgensen TB, et al. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care 2010;12:17–23.
  2. Brassard P, Seifert T, Wissenberg M, et al. Phenylephrine decreases frontal lobe oxygenation at rest but not during moderately intense exercise. J Appl Physiol 2010;108:1472–8.
Labels:

Comments

Post a Comment

Popular posts from this blog

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities.  There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...
Post a Comment
Read more

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more