title: Current trends in vasopressor use to the operating room: A pharmacoepidemiologic study in French teaching and military hospitals.
abstract: OBJECTIVE
  Phenylephrine, ephedrine and norepinephrine are the vasopressors most commonly used in the operating room to treat anaesthesia-induced hypotension. Two new diluted forms of phenylephrine were released in 2011 (500μg/10mL and 500μg/5mL). We initiated a study to evaluate trends in the use of vasopressors in the operating room in French hospitals over the period 2011-2014.
  
  
  METHODS
  We conducted a longitudinal, retrospective, observational study between 2011 and 2014 in French teaching and military hospitals. A questionnaire was sent in February 2015 to hospital pharmacists of each centre to retrospectively collect the consumption of each type of vasopressor. Yearly numbers of vasopressor ampoules were divided by the yearly numbers of anaesthetics recorded. For each vasopressor, we calculated the number of ampoules per 100 anaesthetics recorded (/100A).
  
  
  RESULTS
  Thirty-two hospitals (82%) completed the questionnaire. One hundred per cent of hospitals had registered the diluted form of phenylephrine (61% had chosen the dilution 500μg/10mL), whereas concentrated ampoules were available in 68% of hospitals. Over the period, an exponential increase in the use of diluted phenylephrine was observed (from 1.0 ampoule/100A in 2012 to 31.7 in 2014), the use of ephedrine remained stable (26 ampoules and 17 prefilled syringe/100A), and use of norepinephrine trended upwards (from 6.7 to 8.2 ampoules/100A).
  
  
  CONCLUSIONS
  The use of diluted phenylephrine has exponentially increased without reducing consumption of other vasopressors. This trend might be secondary to practice changes in hypotension treatment following the release of French guidelines in 2013 related to fluid management, the restriction of indications of hydroxylethyl-starch solutions in 2013, and a better knowledge of the benefit of blood pressure optimisation to reduce postoperative morbidity.
authors.affiliation: Service d'anesthésie-réanimation, hospices civils de Lyon, groupement hospitalier Sud, Claude-Bernard université Lyon 1, 69310 Pierre-Bénite, France. Electronic address: melanie.bauducel@chu-lyon.fr.
authors.forename: M
authors.initials: M
authors.lastname: Bauducel
authors.affiliation: Service d'anesthésie-réanimation, hospices civils de Lyon, groupement hospitalier Sud, Claude-Bernard université Lyon 1, 69310 Pierre-Bénite, France.
authors.forename: V
authors.initials: V
authors.lastname: Piriou
authors.affiliation: Service de pharmacie, hôpital d'instruction des armées Desgenettes, 69003 Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Dussart
authors.affiliation: Service pharmaceutique, UMR-CNRS 5510/MATEIS, hospices civils de Lyon, groupement hospitalier Est, 69500 Bron, France.
authors.forename: G
authors.initials: G
authors.lastname: Aulagner
authors.affiliation: Délégation à la recherche clinique et a l'innovation, cellule innovation, UMR-CNRS 5510/MATEIS, hospices civils de Lyon, 69500 Bron, France.
authors.forename: X
authors.initials: X
authors.lastname: Armoiry
mesh_terms: D000758:Anesthesia / Q000009:adverse effects*; D016503:Drug Delivery Systems; D006772:Hospitals, Military; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy*; D009873:Operating Rooms; D010656:Phenylephrine; D012189:Retrospective Studies; D014481:United States; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine
keywords: Agents vasopresseurs; Ephedrine; Noradrénaline; Norepinephrine; Pharmacoepidemiology; Pharmacoépidémiologie; Phenylephrine; Phényléphrine; Vasoconstrictor agents; Éphédrine