Regional perfusion abnormalities with phenylephrine during normothermic bypass

Catherine O'Dwyer, Lee C. Woodson, Brendan P. Conroy, Cheng Y. Lin, Donald J. Deyo, Tatsuo Uchida, William E. Johnston

    Research output: Contribution to journalArticle

    93 Citations (Scopus)

    Abstract

    Background. Hypotension and vasopressors during cardiopulmonary bypass may contribute to splanchnic ischemia. The effect of restoring aortic pressure on visceral organ, brain, and femoral muscle perfusion during cardiopulmonary bypass by increasing pump flow or infusing phenylephrine was examined. Methods. Twelve anesthetized swine were stabilized on normothermic cardiopulmonary bypass. After baseline measurements, including regional blood flow (radioactive microspheres), aortic pressure was reduced to 40 mm Hg by decreasing the pump flow. Next, aortic pressure was restored to 65 mm Hg either by increasing the pump flow or by titrating phenylephrine. The animals had both interventions in random order. Results. At 40 mm Hg aortic pressure, perfusion to all visceral organs and femoral muscle, but not to the brain, was significantly reduced. Increasing pump flow improved perfusion to the pancreas, colon, and kidneys. In contrast, infusing phenylephrine (2.4 ± 0.6 μg·kg-1·min-1) increased aortic pressure but failed to improve splanchnic perfusion, so that significant perfusion differences existed between the pump flow and phenylephrine intervals. Conclusions. Increasing systemic pressure during cardiopulmonary bypass with phenylephrine causes significantly lower values of splanchnic blood flow than does increasing the pump flow. Administering vasoconstrictors during normothermic cardiopulmonary bypass may mask substantial hypoperfusion of splanchnic organs despite restoration of perfusion pressure.

    Original languageEnglish (US)
    Pages (from-to)728-735
    Number of pages8
    JournalAnnals of Thoracic Surgery
    Volume63
    Issue number3
    DOIs
    StatePublished - Mar 1997

    Fingerprint

    Phenylephrine
    Cardiopulmonary Bypass
    Viscera
    Perfusion
    Arterial Pressure
    Thigh
    Pressure
    Muscles
    Regional Blood Flow
    Brain
    Vasoconstrictor Agents
    Masks
    Microspheres
    Hypotension
    Pancreas
    Colon
    Swine
    Ischemia
    Kidney

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    O'Dwyer, C., Woodson, L. C., Conroy, B. P., Lin, C. Y., Deyo, D. J., Uchida, T., & Johnston, W. E. (1997). Regional perfusion abnormalities with phenylephrine during normothermic bypass. Annals of Thoracic Surgery, 63(3), 728-735. https://doi.org/10.1016/S0003-4975(96)01116-2

    Regional perfusion abnormalities with phenylephrine during normothermic bypass. / O'Dwyer, Catherine; Woodson, Lee C.; Conroy, Brendan P.; Lin, Cheng Y.; Deyo, Donald J.; Uchida, Tatsuo; Johnston, William E.

    In: Annals of Thoracic Surgery, Vol. 63, No. 3, 03.1997, p. 728-735.

    Research output: Contribution to journalArticle

    O'Dwyer, C, Woodson, LC, Conroy, BP, Lin, CY, Deyo, DJ, Uchida, T & Johnston, WE 1997, 'Regional perfusion abnormalities with phenylephrine during normothermic bypass', Annals of Thoracic Surgery, vol. 63, no. 3, pp. 728-735. https://doi.org/10.1016/S0003-4975(96)01116-2
    O'Dwyer, Catherine ; Woodson, Lee C. ; Conroy, Brendan P. ; Lin, Cheng Y. ; Deyo, Donald J. ; Uchida, Tatsuo ; Johnston, William E. / Regional perfusion abnormalities with phenylephrine during normothermic bypass. In: Annals of Thoracic Surgery. 1997 ; Vol. 63, No. 3. pp. 728-735.
    @article{336f0beaa12c45feb9a5f5db4fa1562f,
    title = "Regional perfusion abnormalities with phenylephrine during normothermic bypass",
    abstract = "Background. Hypotension and vasopressors during cardiopulmonary bypass may contribute to splanchnic ischemia. The effect of restoring aortic pressure on visceral organ, brain, and femoral muscle perfusion during cardiopulmonary bypass by increasing pump flow or infusing phenylephrine was examined. Methods. Twelve anesthetized swine were stabilized on normothermic cardiopulmonary bypass. After baseline measurements, including regional blood flow (radioactive microspheres), aortic pressure was reduced to 40 mm Hg by decreasing the pump flow. Next, aortic pressure was restored to 65 mm Hg either by increasing the pump flow or by titrating phenylephrine. The animals had both interventions in random order. Results. At 40 mm Hg aortic pressure, perfusion to all visceral organs and femoral muscle, but not to the brain, was significantly reduced. Increasing pump flow improved perfusion to the pancreas, colon, and kidneys. In contrast, infusing phenylephrine (2.4 ± 0.6 μg·kg-1·min-1) increased aortic pressure but failed to improve splanchnic perfusion, so that significant perfusion differences existed between the pump flow and phenylephrine intervals. Conclusions. Increasing systemic pressure during cardiopulmonary bypass with phenylephrine causes significantly lower values of splanchnic blood flow than does increasing the pump flow. Administering vasoconstrictors during normothermic cardiopulmonary bypass may mask substantial hypoperfusion of splanchnic organs despite restoration of perfusion pressure.",
    author = "Catherine O'Dwyer and Woodson, {Lee C.} and Conroy, {Brendan P.} and Lin, {Cheng Y.} and Deyo, {Donald J.} and Tatsuo Uchida and Johnston, {William E.}",
    year = "1997",
    month = "3",
    doi = "10.1016/S0003-4975(96)01116-2",
    language = "English (US)",
    volume = "63",
    pages = "728--735",
    journal = "Annals of Thoracic Surgery",
    issn = "0003-4975",
    publisher = "Elsevier USA",
    number = "3",

    }

    TY - JOUR

    T1 - Regional perfusion abnormalities with phenylephrine during normothermic bypass

    AU - O'Dwyer, Catherine

    AU - Woodson, Lee C.

    AU - Conroy, Brendan P.

    AU - Lin, Cheng Y.

    AU - Deyo, Donald J.

    AU - Uchida, Tatsuo

    AU - Johnston, William E.

    PY - 1997/3

    Y1 - 1997/3

    N2 - Background. Hypotension and vasopressors during cardiopulmonary bypass may contribute to splanchnic ischemia. The effect of restoring aortic pressure on visceral organ, brain, and femoral muscle perfusion during cardiopulmonary bypass by increasing pump flow or infusing phenylephrine was examined. Methods. Twelve anesthetized swine were stabilized on normothermic cardiopulmonary bypass. After baseline measurements, including regional blood flow (radioactive microspheres), aortic pressure was reduced to 40 mm Hg by decreasing the pump flow. Next, aortic pressure was restored to 65 mm Hg either by increasing the pump flow or by titrating phenylephrine. The animals had both interventions in random order. Results. At 40 mm Hg aortic pressure, perfusion to all visceral organs and femoral muscle, but not to the brain, was significantly reduced. Increasing pump flow improved perfusion to the pancreas, colon, and kidneys. In contrast, infusing phenylephrine (2.4 ± 0.6 μg·kg-1·min-1) increased aortic pressure but failed to improve splanchnic perfusion, so that significant perfusion differences existed between the pump flow and phenylephrine intervals. Conclusions. Increasing systemic pressure during cardiopulmonary bypass with phenylephrine causes significantly lower values of splanchnic blood flow than does increasing the pump flow. Administering vasoconstrictors during normothermic cardiopulmonary bypass may mask substantial hypoperfusion of splanchnic organs despite restoration of perfusion pressure.

    AB - Background. Hypotension and vasopressors during cardiopulmonary bypass may contribute to splanchnic ischemia. The effect of restoring aortic pressure on visceral organ, brain, and femoral muscle perfusion during cardiopulmonary bypass by increasing pump flow or infusing phenylephrine was examined. Methods. Twelve anesthetized swine were stabilized on normothermic cardiopulmonary bypass. After baseline measurements, including regional blood flow (radioactive microspheres), aortic pressure was reduced to 40 mm Hg by decreasing the pump flow. Next, aortic pressure was restored to 65 mm Hg either by increasing the pump flow or by titrating phenylephrine. The animals had both interventions in random order. Results. At 40 mm Hg aortic pressure, perfusion to all visceral organs and femoral muscle, but not to the brain, was significantly reduced. Increasing pump flow improved perfusion to the pancreas, colon, and kidneys. In contrast, infusing phenylephrine (2.4 ± 0.6 μg·kg-1·min-1) increased aortic pressure but failed to improve splanchnic perfusion, so that significant perfusion differences existed between the pump flow and phenylephrine intervals. Conclusions. Increasing systemic pressure during cardiopulmonary bypass with phenylephrine causes significantly lower values of splanchnic blood flow than does increasing the pump flow. Administering vasoconstrictors during normothermic cardiopulmonary bypass may mask substantial hypoperfusion of splanchnic organs despite restoration of perfusion pressure.

    UR - http://www.scopus.com/inward/record.url?scp=0030937864&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=0030937864&partnerID=8YFLogxK

    U2 - 10.1016/S0003-4975(96)01116-2

    DO - 10.1016/S0003-4975(96)01116-2

    M3 - Article

    VL - 63

    SP - 728

    EP - 735

    JO - Annals of Thoracic Surgery

    JF - Annals of Thoracic Surgery

    SN - 0003-4975

    IS - 3

    ER -