PMID- 32718724
OWN - NLM
STAT- MEDLINE
DCOM- 20201009
LR  - 20211002
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Print)
IS  - 0007-0912 (Linking)
VI  - 125
IP  - 4
DP  - 2020 Oct
TI  - Effects of dobutamine and phenylephrine on cerebral perfusion in patients 
      undergoing cerebral bypass surgery: a randomised crossover trial.
PG  - 539-547
LID - S0007-0912(20)30422-0 [pii]
LID - 10.1016/j.bja.2020.05.040 [doi]
AB  - BACKGROUND: Patients undergoing cerebral bypass surgery are prone to cerebral 
      hypoperfusion. Currently, arterial blood pressure is often increased with 
      vasopressors to prevent cerebral ischaemia. However, this might cause 
      vasoconstriction of the graft and cerebral vasculature and decrease perfusion. We 
      hypothesised that cardiac output, rather than arterial blood pressure, is 
      essential for adequate perfusion and aimed to determine whether dobutamine 
      administration resulted in greater graft perfusion than phenylephrine 
      administration. METHODS: This randomised crossover study included 10 adult 
      patients undergoing cerebral bypass surgery. Intraoperatively, patients randomly 
      and sequentially received dobutamine to increase cardiac index or phenylephrine 
      to increase mean arterial pressure (MAP). An increase of >10% in cardiac index or 
      >10% in MAP was targeted, respectively. Before both interventions, a reference 
      phase was implemented. The primary outcome was the absolute difference in graft 
      flow between the reference and intervention phase. We compared the absolute flow 
      difference between each intervention and constructed a random-effect linear 
      regression model to explore treatment and carry-over effects. RESULTS: Graft flow 
      increased with a median of 4.1 (inter-quartile range [IQR], 1.7-12.0] ml min(-1)) 
      after dobutamine administration and 3.6 [IQR, 1.3-7.8] ml min(-1) after 
      phenylephrine administration (difference -0.6 ml min(-1); 95% confidence interval 
      [CI], -14.5 to 5.3; P=0.441). There was no treatment effect (0.9 ml min(-1); 95% 
      CI, 0.0-20.1; P=0.944) and no carry-over effect. CONCLUSIONS: Both dobutamine and 
      phenylephrine increased graft flow during cerebral bypass surgery, without a 
      preference for one method over the other. CLINICAL TRIAL REGISTRATION: 
      Netherlands Trial Register, NL7077 (https://www.trialregister.nl/trial/7077).
CI  - Copyright (c) 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
FAU - Akkermans, Annemarie
AU  - Akkermans A
AD  - Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht 
      University, Utrecht, the Netherlands. Electronic address: 
      a.akkermans@umcutrecht.nl.
FAU - van Waes, Judith A R
AU  - van Waes JAR
AD  - Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht 
      University, Utrecht, the Netherlands.
FAU - van Doormaal, Tristan P C
AU  - van Doormaal TPC
AD  - Department of Neurology and Neurosurgery, Brain Centre, University Medical Centre 
      Utrecht, Utrecht University, Utrecht, the Netherlands; Department of 
      Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
FAU - de Waal, Eric E C
AU  - de Waal EEC
AD  - Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht 
      University, Utrecht, the Netherlands.
FAU - Rinkel, Gabriel J E
AU  - Rinkel GJE
AD  - Department of Neurology and Neurosurgery, Brain Centre, University Medical Centre 
      Utrecht, Utrecht University, Utrecht, the Netherlands.
FAU - van der Zwan, Albert
AU  - van der Zwan A
AD  - Department of Neurology and Neurosurgery, Brain Centre, University Medical Centre 
      Utrecht, Utrecht University, Utrecht, the Netherlands.
FAU - Kalkman, Cor J
AU  - Kalkman CJ
AD  - Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht 
      University, Utrecht, the Netherlands.
FAU - van Klei, Wilton A
AU  - van Klei WA
AD  - Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht 
      University, Utrecht, the Netherlands.
LA  - eng
SI  - NTR/NL7077
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20200724
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - 1WS297W6MV (Phenylephrine)
RN  - 3S12J47372 (Dobutamine)
SB  - IM
MH  - Adult
MH  - Arterial Pressure/drug effects
MH  - Cardiac Output/drug effects
MH  - Cerebral Revascularization/*methods
MH  - Cerebrovascular Circulation/*drug effects
MH  - Cross-Over Studies
MH  - Dobutamine/*pharmacology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Phenylephrine/*pharmacology
PMC - PMC7565906
OTO - NOTNLM
OT  - blood pressure
OT  - cardiac output
OT  - cerebral bypass surgery
OT  - cerebral ischaemia
OT  - cerebral perfusion
EDAT- 2020/07/29 06:00
MHDA- 2020/10/10 06:00
PMCR- 2021/10/01
CRDT- 2020/07/29 06:00
PHST- 2020/02/07 00:00 [received]
PHST- 2020/04/20 00:00 [revised]
PHST- 2020/05/13 00:00 [accepted]
PHST- 2020/07/29 06:00 [pubmed]
PHST- 2020/10/10 06:00 [medline]
PHST- 2020/07/29 06:00 [entrez]
PHST- 2021/10/01 00:00 [pmc-release]
AID - S0007-0912(20)30422-0 [pii]
AID - 10.1016/j.bja.2020.05.040 [doi]
PST - ppublish
SO  - Br J Anaesth. 2020 Oct;125(4):539-547. doi: 10.1016/j.bja.2020.05.040. Epub 2020 
      Jul 24.