title: Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral Oxygen Saturation in Thoracic Surgery: A Randomized Controlled Trial.
abstract: Fluid is usually restricted during thoracic surgery, and vasoactive agents are often administered to maintain blood pressure. One-lung ventilation (OLV) decreases arterial oxygenation; thus oxygen delivery to the brain can be decreased. In this study, we compared phenylephrine and dopamine with respect to maintaining cerebral oxygenation during OLV in major thoracic surgery.Sixty-three patients undergoing lobectomies were randomly assigned to the dopamine (D) or phenylephrine (P) group. The patients' mean arterial pressure was maintained within 20% of baseline by a continuous infusion of dopamine or phenylephrine. Maintenance fluid was kept at 5 mL/kg/h. The depth of anesthesia was maintained with desflurane 1MAC and remifentanil infusion under bispectral index guidance. Regional cerebral oxygen saturation (rScO2) and hemodynamic variables were recorded using near-infrared spectroscopy and esophageal cardiac Doppler.The rScO2 was higher in the D group than the P group during OLV (OLV 60 min: 71 ± 6% vs 63 ± 12%; P = 0.03). The number of patients whose rScO2 dropped more than 20% from baseline was 0 and 6 in the D and P groups, respectively (P = 0.02). The D group showed higher cardiac output, but lower mean arterial pressure than the P group (4.7 ± 1.0 vs 3.9 ± 1.2 L/min; 76.7 ± 8.1 vs 84.5 ± 7.5 mm Hg; P = 0.02, P = 0.02). Among the variables, age, hemoglobin concentration, and cardiac output were associated with rScO2 by correlation analysis.Dopamine was superior to phenylephrine in maintaining cerebral oxygenation during OLV in thoracic surgery.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Choi
authors.forename: Hyun
authors.initials: H
authors.lastname: Joo Ahn
authors.forename: Mikyung
authors.initials: M
authors.lastname: Yang
authors.forename: Jie Ae
authors.initials: JA
authors.lastname: Kim
authors.forename: Sangmin M
authors.initials: SM
authors.lastname: Lee
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Ahn
mesh_terms: D000367:Age Factors; D000368:Aged; D002302:Cardiac Output; D002560:Cerebrovascular Circulation; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D061810:One-Lung Ventilation; D010100:Oxygen / Q000097:blood*; D010656:Phenylephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D011013:Pneumonectomy / Q000379:methods*; D013566:Sympathomimetics / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D006454:Hemoglobins; D013566:Sympathomimetics; D010656:Phenylephrine; D010100:Oxygen; D004298:Dopamine