Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study
Abstract Background Intraoperative arterial hypotension (IOH) leads to increased postoperative morbidity. Norepinephrine is often use to treat IOH. The question regarding the mode of administration in either a bolus or continuous infusion remains unanswered. The aim of the present study was to descr...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02342-3 |
| _version_ | 1797556949526511616 |
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| author | Manuel Kindermans Jona Joachim Elsa Manquat Charlotte Levé Alex Hong Joachim Mateo Alexandre Mebazaa Etienne Gayat Daniel De Backer Fabrice Vallée |
| author_facet | Manuel Kindermans Jona Joachim Elsa Manquat Charlotte Levé Alex Hong Joachim Mateo Alexandre Mebazaa Etienne Gayat Daniel De Backer Fabrice Vallée |
| author_sort | Manuel Kindermans |
| collection | DOAJ |
| description | Abstract Background Intraoperative arterial hypotension (IOH) leads to increased postoperative morbidity. Norepinephrine is often use to treat IOH. The question regarding the mode of administration in either a bolus or continuous infusion remains unanswered. The aim of the present study was to describe and compare the effects on macrocirculation and microcirculation of a bolus and a continuous infusion of norepinephrine to treat IOH. Methods We conducted a prospective observational study with adult patients who underwent neurosurgery. Patients with invasive arterial blood pressure and cardiac output (CO) monitoring were screened for inclusion. All patients underwent microcirculation monitoring by video-capillaroscopy, laser doppler, near-infrared spectroscopy technology, and tissular CO2. In case of IOH, the patient could receive either a bolus of 10 µg or a continuous infusion of 200 µg/h of norepinephrine. Time analysis for comparison between bolus and continuous infusion were at peak of MAP. The primary outcome was MFI by videocapillaroscopy. Results Thirty-five patients were included, with 41 boluses and 33 continuous infusion. Bolus and continuous infusion induced an maximal increase in mean arterial pressure of +30[20-45] and +23[12-34] %, respectively (P=0,07). For macrocirculatory parameters, continuous infusion was associated with a smaller decrease in CO and stroke volume (p<0.05). For microcirculatory parameters, microvascular flow index (-0,1 vs. + 0,3, p=0,03), perfusion index (-12 vs. +12%, p=0,008), total vessel density (-0,2 vs. +2,3 mm2/mm2, p=0,002), showed significant opposite variations with bolus and continuous infusion, respectively. Conclusions These results on macro and microcirculation enlighten the potential benefits of a continuous infusion of norepinephrine rather than a bolus to treat anaesthesia-induced hypotension. Trial registration (NOR-PHARM: 1-17-42 Clinical Trials: NCT03454204), 05/03/2018 |
| first_indexed | 2024-03-10T17:10:26Z |
| format | Article |
| id | doaj.art-b0bdd6bf6d6f479fab9c00e8f1be2004 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-10T17:10:26Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-b0bdd6bf6d6f479fab9c00e8f1be20042023-11-20T10:42:09ZengBMCBMC Anesthesiology1471-22532023-11-0123111110.1186/s12871-023-02342-3Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary studyManuel Kindermans0Jona Joachim1Elsa Manquat2Charlotte Levé3Alex Hong4Joachim Mateo5Alexandre Mebazaa6Etienne Gayat7Daniel De Backer8Fabrice Vallée9Department of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsCHIRECDepartment of Anaesthesiology and Intensive Care, Lariboisière - Saint Louis HospitalsAbstract Background Intraoperative arterial hypotension (IOH) leads to increased postoperative morbidity. Norepinephrine is often use to treat IOH. The question regarding the mode of administration in either a bolus or continuous infusion remains unanswered. The aim of the present study was to describe and compare the effects on macrocirculation and microcirculation of a bolus and a continuous infusion of norepinephrine to treat IOH. Methods We conducted a prospective observational study with adult patients who underwent neurosurgery. Patients with invasive arterial blood pressure and cardiac output (CO) monitoring were screened for inclusion. All patients underwent microcirculation monitoring by video-capillaroscopy, laser doppler, near-infrared spectroscopy technology, and tissular CO2. In case of IOH, the patient could receive either a bolus of 10 µg or a continuous infusion of 200 µg/h of norepinephrine. Time analysis for comparison between bolus and continuous infusion were at peak of MAP. The primary outcome was MFI by videocapillaroscopy. Results Thirty-five patients were included, with 41 boluses and 33 continuous infusion. Bolus and continuous infusion induced an maximal increase in mean arterial pressure of +30[20-45] and +23[12-34] %, respectively (P=0,07). For macrocirculatory parameters, continuous infusion was associated with a smaller decrease in CO and stroke volume (p<0.05). For microcirculatory parameters, microvascular flow index (-0,1 vs. + 0,3, p=0,03), perfusion index (-12 vs. +12%, p=0,008), total vessel density (-0,2 vs. +2,3 mm2/mm2, p=0,002), showed significant opposite variations with bolus and continuous infusion, respectively. Conclusions These results on macro and microcirculation enlighten the potential benefits of a continuous infusion of norepinephrine rather than a bolus to treat anaesthesia-induced hypotension. Trial registration (NOR-PHARM: 1-17-42 Clinical Trials: NCT03454204), 05/03/2018https://doi.org/10.1186/s12871-023-02342-3NorepinephrineBolusContinuous infusionMicrocirculationMicrocirculationMicroflow index |
| spellingShingle | Manuel Kindermans Jona Joachim Elsa Manquat Charlotte Levé Alex Hong Joachim Mateo Alexandre Mebazaa Etienne Gayat Daniel De Backer Fabrice Vallée Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study BMC Anesthesiology Norepinephrine Bolus Continuous infusion Microcirculation Microcirculation Microflow index |
| title | Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study |
| title_full | Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study |
| title_fullStr | Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study |
| title_full_unstemmed | Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study |
| title_short | Micro- and macrocirculatory effects of norepinephrine on anaesthesia-induced hypotension: a prospective preliminary study |
| title_sort | micro and macrocirculatory effects of norepinephrine on anaesthesia induced hypotension a prospective preliminary study |
| topic | Norepinephrine Bolus Continuous infusion Microcirculation Microcirculation Microflow index |
| url | https://doi.org/10.1186/s12871-023-02342-3 |
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