Newly Published
Perioperative Medicine  |   May 2020
Ephedrine versus Phenylephrine Effect on Cerebral Blood Flow and Oxygen Consumption in Anesthetized Brain Tumor Patients: A Randomized Clinical Trial
Author Notes
  • From the Department of Anesthesiology, Section of Neuroanesthesia (K.U.K., N.J., L.N., M.R.), Department of Nuclear Medicine and PET Center (J.A.), Department of Neurosurgery (G.v.O.), and Department of Neuroradiology (L.Ø.), Aarhus University Hospital, Aarhus, Denmark; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Anesthesiology, Horsens Regional Hospital, Horsens, Denmark (U.S.E.); Institute of Neuroradiology, Charité, Universitätsmedizin, Berlin, Germany (A.T.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Portions of this work were presented as part of a poster presentation at the Annual Society for Neuroscience in Anesthesiology and Critical Care (SNACC) meeting, October 20, 2017 in Boston, Massachusetts, and October 12, 2018 in San Francisco, California.
    Portions of this work were presented as part of a poster presentation at the Annual Society for Neuroscience in Anesthesiology and Critical Care (SNACC) meeting, October 20, 2017 in Boston, Massachusetts, and October 12, 2018 in San Francisco, California.×
  • Submitted for publication October 10, 2019. Accepted for publication April 20, 2020.
    Submitted for publication October 10, 2019. Accepted for publication April 20, 2020.×
  • Correspondence: Address correspondence to Dr. Koch: Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, 8000 Aarhus C, Denmark. klaukoch@rm.dk. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Neurosurgical Anesthesia / Respiratory System
Perioperative Medicine   |   May 2020
Ephedrine versus Phenylephrine Effect on Cerebral Blood Flow and Oxygen Consumption in Anesthetized Brain Tumor Patients: A Randomized Clinical Trial
Anesthesiology Newly Published on May 28, 2020. doi:https://doi.org/10.1097/ALN.0000000000003377
Anesthesiology Newly Published on May 28, 2020. doi:https://doi.org/10.1097/ALN.0000000000003377
Abstract

Background: Studies in anesthetized patients suggest that phenylephrine reduces regional cerebral oxygen saturation compared with ephedrine. The present study aimed to quantify the effects of phenylephrine and ephedrine on cerebral blood flow and cerebral metabolic rate of oxygen in brain tumor patients. The authors hypothesized that phenylephrine reduces cerebral metabolic rate of oxygen in selected brain regions compared with ephedrine.

Methods: In this double-blinded, randomized clinical trial, 24 anesthetized patients with brain tumors were randomly assigned to ephedrine or phenylephrine treatment. Positron emission tomography measurements of cerebral blood flow and cerebral metabolic rate of oxygen in peritumoral and normal contralateral regions were performed before and during vasopressor infusion. The primary endpoint was between-group difference in cerebral metabolic rate of oxygen. Secondary endpoints included changes in cerebral blood flow, oxygen extraction fraction, and regional cerebral oxygen saturation.

Results: Peritumoral mean ± SD cerebral metabolic rate of oxygen values before and after vasopressor (ephedrine, 67.0 ± 11.3 and 67.8 ± 25.7 μmol · 100 g−1 · min−1; phenylephrine, 68.2 ± 15.2 and 67.6 ± 18.0 μmol · 100 g−1 · min−1) showed no intergroup difference (difference [95% CI], 1.5 [−13.3 to 16.3] μmol · 100 g−1 · min−1 [P = 0.839]). Corresponding contralateral hemisphere cerebral metabolic rate of oxygen values (ephedrine, 90.8 ± 15.9 and 94.6 ± 16.9 μmol · 100 g−1 · min−1; phenylephrine, 100.8 ± 20.7 and 96.4 ± 17.7 μmol · 100 g−1 · min−1) showed no intergroup difference (difference [95% CI], 8.2 [−2.0 to 18.5] μmol · 100 g−1 · min−1 [P = 0.118]). Ephedrine significantly increased cerebral blood flow (difference [95% CI], 3.9 [0.7 to 7.0] ml · 100 g−1 · min−1 [P = 0.019]) and regional cerebral oxygen saturation (difference [95% CI], 4 [1 to 8]% [P = 0.024]) in the contralateral hemisphere compared to phenylephrine. The change in oxygen extraction fraction in both regions (peritumoral difference [95% CI], −0.6 [−14.7 to 13.6]% [P = 0.934]; contralateral hemisphere difference [95% CI], −0.1 [− 12.1 to 12.0]% [P = 0.989]) were comparable between groups.

Conclusions: The cerebral metabolic rate of oxygen changes in peritumoral and normal contralateral regions were similar between ephedrine- and phenylephrine-treated patients. In the normal contralateral region, ephedrine was associated with an increase in cerebral blood flow and regional cerebral oxygen saturation compared with phenylephrine.

Editor’s Perspective:

What We Already Know about This Topic:

  • Phenylepherine may reduce regional cerebral oxygen saturation in anesthetized patients without cerebral pathology when compared with ephedrine

What This Article Tells Us That Is New:

  • In adult patients with brain tumors, there were no differences in cerebral metabolic rate of oxygen in peritumoral regions or in the contralateral cerebral hemisphere after administration of ephedrine or phenylepherine