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De vergelijking van het effect van fenylefrine en noradrenaline op de hemodynamiek en weefseloxygenatie bij patiënten tijdensoogheelkundige chirurgie.

(2012) Poterman, M.

Background:
In ophthalmic surgery the specific anesthesiological challenges necessitate the administration of a combination of relatively high doses of hypnotics and analgesics. In order to preserve adequate arterial blood pressure, there is often a need to administer vasoactive agents for hemodynamic support. Depending on the experience of the anaesthetist a continuous infusion of phenylephrine or norepinephrine is used. It is currently not known which specific effects these agents have on advanced hemodynamic parameters and tissue oxygenation in a surgical patient population, such as in ophthalmic surgery.
The availability of the new monitoring devices Nexfin, FORE-SIGHT® and InSpectra™ allows us to observe advanced hemodynamic parameters, cerebral (SctO2) and peripheral (StO2) tissue oxygenation in a non-invasive and continuous matter.
Objective:
To determine whether phenylephrine or norepinephrine has superior effects on hemodynamic parameters and tissue oxygenation in patients under deep general anesthesia during ophthalmic surgery.
Methods:
In this double blind, randomized controlled trial, 60 patients under general anesthesia for ophthalmic surgery were included after local ethics committee approval and written informed consent. MAP, HR, CO, SctO2, StO2 and systemic vascular resistance (SVR) were continuously recorded during the procedure. Patients were randomly assigned to treatment with phenylephrine or norepinephrine. Anesthesia was provided with propofol and remifentanil. If the MAP dropped below 90mmHg, a bolus of 1 ml phenylephrine (100 µg /ml) or 1 ml norepinephrine (10 µg/ml) administered followed by a continuous infusion of 0,3 ml/kg/min. If the HR dropped below 60/min, an single bolus of atropine 500 μg was administered.
Results:
54 patients were analyzed, 26 received phenylephrine and 28 norepinephrine. Significant differences between phenylephrine and norepinephrine 5 minutes after administration were only found in SctO2. Treatment with phenylephrine resulted in a significantly lower SctO2 than with norepinephrine. In both groups, a significant increase in MAP and SVR was seen and a significant decrease in HR, CO and SctO2. The StO2 did not change in the phenylephrine group, whereas a significant decrease in StO2 was found in the norepinephrine group.
Conclusion:
Both phenylephrine and norepinephrine increase arterial blood pressure along with a decrease in cardiac output. Additionally, phenylephrine has a negative effect on the cerebral tissue oxygenation.





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