WFRF:(Nygren Andreas 1967)
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- Nygren, Andreas,1967Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper,Institute of Clinical Sciences (författare)
Vasopressors and intestinal mucosal perfusion after cardiac surgery: Norepinephrine vs. phenylephrine.
- Artikel/kapitelEngelska2006
Förlag, utgivningsår, omfång ...
- 2006
Nummerbeteckningar
- LIBRIS-ID:oai:gup.ub.gu.se/53717
- https://gup.ub.gu.se/publication/53717URI
- https://doi.org/10.1097/01.CCM.0000201879.20281.C6DOI
Kompletterande språkuppgifter
- Språk:engelska
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- SwePubSwePub
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Anmärkningar
- OBJECTIVES: To evaluate the potential differential effects of norepinephrine, an alpha1-, beta1-, and beta2-receptor agonist, to the alpha1-agonist phenylephrine on jejunal mucosal perfusion, gastric-arterial PCO2 gradient, and the global splanchnic oxygen demand-supply relationship after cardiac surgery. DESIGN: A randomized, prospective, interventional crossover study. SETTING: A university cardiothoracic intensive care unit. PATIENTS: Ten patients were studied during propofol sedation and mechanical ventilation after uncomplicated coronary artery bypass surgery. INTERVENTIONS: Each patient received randomly and sequentially norepinephrine (0.052+/-0.009 microg/kg/min) and phenylephrine (0.50+/-0.22 microg/kg/min) to increase mean arterial blood pressure by 30%. MEASUREMENTS AND MAIN RESULTS: Data on jejunal mucosal perfusion, jejunal mucosal hematocrit, and red blood cell velocity (laser Doppler flowmetry) as well as gastric-arterial Pco2 gradient (tonometry) and splanchnic oxygen extraction were obtained before (control) and during a 30-min drug infusion period after the target mean arterial blood pressure was reached. The procedure was sequentially repeated for the second vasopressor. Both drugs induced a 40-46% increase in systemic vascular resistance with no change in cardiac index. Neither jejunal mucosal perfusion, jejunal mucosal hematocrit, red blood cell velocity, nor gastric-arterial Pco2 gradient was affected by any of the vasopressors. Splanchnic oxygen extraction increased from 38.2% to 43.1% (p<.001) with norepinephrine and from 39.3% to 47.5% (p<.001) with phenylephrine. This increase was significantly more pronounced with phenylephrine compared with norepinephrine (p<.05). Mixed venous-hepatic vein oxygen saturation gradient increased with both drugs (p<.01), and the increase was more pronounced with phenylephrine (p<.05). Splanchnic lactate extraction was not significantly affected by any of the vasopressors. CONCLUSIONS: Phenylephrine induced a more pronounced global alpha1-mediated splanchnic vasoconstriction compared with norepinephrine. Neither of the vasoconstrictors impaired perfusion of the gastrointestinal mucosa in postcardiac surgery patients. The lack of norepinephrine-induced, alpha1-mediated impairment of gastrointestinal perfusion is not explained by a beta2-mediated counteractive vasodilation but instead by possible mucosal autoregulatory escape.
Ämnesord och genrebeteckningar
- Aged
- Analysis of Variance
- Cardiac Surgical Procedures
- Cross-Over Studies
- Female
- Gastric Mucosa
- blood supply
- Hemodynamic Processes
- Humans
- Intestinal Mucosa
- blood supply
- drug effects
- Jejunum
- blood supply
- Laser-Doppler Flowmetry
- Male
- Microcirculation
- Middle Aged
- Norepinephrine
- pharmacology
- Phenylephrine
- pharmacology
- Shock
- Surgical
- prevention & control
- Splanchnic Circulation
- drug effects
- Vasoconstrictor Agents
- pharmacology
Biuppslag (personer, institutioner, konferenser, titlar ...)
- Thorén, Anders,1955Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper,Institute of Clinical Sciences(Swepub:gu)xthand (författare)
- Ricksten, Sven-Erik,1953Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper,Institute of Clinical Sciences(Swepub:gu)xricsv (författare)
- Göteborgs universitetInstitutionen för kliniska vetenskaper (creator_code:org_t)
Sammanhörande titlar
- Ingår i:Critical care medicine34:3, s. 722-90090-3493
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