title: Compared effects on cerebral oxygenation of ephedrine vs phenylephrine to treat hypotension during carotid endarterectomy.
abstract: While both ephedrine and phenylephrine are currently used to treat hypotension occurring during carotid endarterectomy (CEA) under general anaesthesia, phenylephrine may have deleterious effects on the cerebral watershed, due to its exclusively vasoconstrictive action. In this controlled, double-blind randomised trial, we compared the effects of ephedrine and phenylephrine administered in a standardised algorithm to treat the first hypotensive event occurring since induction of anaesthesia until carotid cross-clamping. The algorithm consisted of 1-to-3 boluses of 6 mg of ephedrine or 50 μg of phenylephrine, after a goal-directed fluid therapy. In case of failure, the treatment switched to the other study drug. Cerebral tissue oxygen saturation (SctO2) was monitored by near infrared spectroscopy (NIRS), and the primary outcome was the restoring effect of SctO2(ipsilateral to surgery) to baseline values. Secondary postoperative outcomes were: contralateral SctO2, neurological outcomes, and plasma S100B protein measured at discharge from post-anaesthesia care unit. Ephedrine treatment provided a higher rate of restoration of ipsilateral SctO2than phenylephrine (93.2% vs 85.1%, P=.034); this was also noted for contralateral SctO2(93.5% vs 90.7%, P=.026). The gain in SctO2on the lowest value during hypotension was also higher under ephedrine than phenylephrine (6.4% vs 4.3% ipsilateral, 5.1% vs 4% contralateral), but not significantly so. Clinical outcomes were unaffected by the treatment, but S100B protein plasma concentration was higher in the phenylephrine group. To conclude, this pilot trial, focusing on intermediate outcomes, suggests that ephedrine should be preferred to phenylephrine to treat hypotension during CEA.
authors.affiliation: CHU Clermont-Ferrand, Médecine Péri-Opératoire, Clermont-Ferrand, France.
authors.forename: Jugurtha
authors.initials: J
authors.lastname: Aliane
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France.|Inserm, CIC1405 & U1107 Neuro-Dol, Clermont-Ferrand, France.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0002-2333-7357
authors.initials: C
authors.lastname: Dualé
authors.affiliation: CHU Clermont-Ferrand, Médecine Péri-Opératoire, Clermont-Ferrand, France.
authors.forename: Nader
authors.initials: N
authors.lastname: Guesmi
authors.affiliation: CHU Clermont-Ferrand, Médecine Péri-Opératoire, Clermont-Ferrand, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Baud
authors.affiliation: CHU Clermont-Ferrand, Chirurgie Vasculaire, Clermont-Ferrand, France.|Univ Clermont1, Clermont-Ferrand, France.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Rosset
authors.affiliation: Direction de la Recherche Clinique et des Innovations, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: CHU Clermont-Ferrand, Biochimie Médicale et Biologie Moléculaire, Clermont-Ferrand, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bouvier
authors.affiliation: CHU Clermont-Ferrand, Médecine Péri-Opératoire, Clermont-Ferrand, France.|Univ Clermont1, Clermont-Ferrand, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Schoeffler
mesh_terms: D000368:Aged; D001921:Brain / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism*; D007093:Imidazoles / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D010656:Phenylephrine / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D007093:Imidazoles; D010656:Phenylephrine; C002676:ethefil; D010100:Oxygen
keywords: anaesthesia; general adverse effects; near infrared; spectroscopy; vasoconstrictor agents adverse effects