Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass

Influence of Pa(CO2) management

A. T. Rogers, D. A. Stump, G. P. Gravlee, Donald Prough, K. C. Angert, S. L. Wallenhaupt, R. C. Roy, J. Phipps

Research output: Contribution to journalArticle

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Abstract

Twenty-eight adult patients anesthetized with fentanyl, then subjected to hypothermic cardiopulmonary bypass (CPB), were studied to determine the effect of phenylephrine-induced changes in mean arterial pressure (MAP) on cerebral blood flow (CBF). During CPB patients managed at 28°C with either alpha-stat (temperature-uncorrected Pa(CO2) = 41 ± 4 mmHg) or pH-stat (temperature-uncorrected Pa(CO2) = 54 ± 8 mmHg) Pa(CO2) for blood gas maintenance received phenylephrine to increase MAP ≥ 25% (group A, n = 10; group B, n = 6). To correct for a spontaneous, time-related decline in CBF observed during CPB, two additional groups of patients undergoing CPB were either managed with the alpha-stat or pH-stat approach, but neither group received phenylephrine and MAP remained unchanged in both groups (group C, n = 6; group D, n = 6). For all patients controlled variables (nasopharyngeal temperature, Pa(CO2), pump flow, and hematocrit) remained unchanged between measurements. Phenylephrine data were corrected based on the data from groups C and D for the effect of diminishing CBF over time during CPB. In patients in group A CBF was unchanged as MAP rose from 56 ± 7 to 84 ± 8 mmHg. In patients in group B CBF increased 41% as MAP rose from 53 ± 8 to 77 ± 9 mmHg (P < 0.001). During hypothermic CPB normocarbia maintained via the alpha-stat approach at a temperature-uncorrected Pa(CO2) of ≃40 mmHg preserves cerebral autoregulation; pH-stat management (Pa(CO2) ≃57 mmHg uncorrected for temperature, or 40 mmHg when corrected to 28°C) causes cerebrovascular changes (i.e., impaired autoregulation) similar to those changes produced by hypercarbia in awake, normothermic patients.

Original languageEnglish (US)
Pages (from-to)547-551
Number of pages5
JournalAnesthesiology
Volume69
Issue number4
StatePublished - 1988
Externally publishedYes

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Cerebrovascular Circulation
Phenylephrine
Cardiopulmonary Bypass
Arterial Pressure
Temperature
Homeostasis
Hypercapnia
Fentanyl
Hematocrit
Gases
Maintenance

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Rogers, A. T., Stump, D. A., Gravlee, G. P., Prough, D., Angert, K. C., Wallenhaupt, S. L., ... Phipps, J. (1988). Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass: Influence of Pa(CO2) management. Anesthesiology, 69(4), 547-551.

Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass : Influence of Pa(CO2) management. / Rogers, A. T.; Stump, D. A.; Gravlee, G. P.; Prough, Donald; Angert, K. C.; Wallenhaupt, S. L.; Roy, R. C.; Phipps, J.

In: Anesthesiology, Vol. 69, No. 4, 1988, p. 547-551.

Research output: Contribution to journalArticle

Rogers, AT, Stump, DA, Gravlee, GP, Prough, D, Angert, KC, Wallenhaupt, SL, Roy, RC & Phipps, J 1988, 'Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass: Influence of Pa(CO2) management', Anesthesiology, vol. 69, no. 4, pp. 547-551.
Rogers, A. T. ; Stump, D. A. ; Gravlee, G. P. ; Prough, Donald ; Angert, K. C. ; Wallenhaupt, S. L. ; Roy, R. C. ; Phipps, J. / Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass : Influence of Pa(CO2) management. In: Anesthesiology. 1988 ; Vol. 69, No. 4. pp. 547-551.
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abstract = "Twenty-eight adult patients anesthetized with fentanyl, then subjected to hypothermic cardiopulmonary bypass (CPB), were studied to determine the effect of phenylephrine-induced changes in mean arterial pressure (MAP) on cerebral blood flow (CBF). During CPB patients managed at 28°C with either alpha-stat (temperature-uncorrected Pa(CO2) = 41 ± 4 mmHg) or pH-stat (temperature-uncorrected Pa(CO2) = 54 ± 8 mmHg) Pa(CO2) for blood gas maintenance received phenylephrine to increase MAP ≥ 25{\%} (group A, n = 10; group B, n = 6). To correct for a spontaneous, time-related decline in CBF observed during CPB, two additional groups of patients undergoing CPB were either managed with the alpha-stat or pH-stat approach, but neither group received phenylephrine and MAP remained unchanged in both groups (group C, n = 6; group D, n = 6). For all patients controlled variables (nasopharyngeal temperature, Pa(CO2), pump flow, and hematocrit) remained unchanged between measurements. Phenylephrine data were corrected based on the data from groups C and D for the effect of diminishing CBF over time during CPB. In patients in group A CBF was unchanged as MAP rose from 56 ± 7 to 84 ± 8 mmHg. In patients in group B CBF increased 41{\%} as MAP rose from 53 ± 8 to 77 ± 9 mmHg (P < 0.001). During hypothermic CPB normocarbia maintained via the alpha-stat approach at a temperature-uncorrected Pa(CO2) of ≃40 mmHg preserves cerebral autoregulation; pH-stat management (Pa(CO2) ≃57 mmHg uncorrected for temperature, or 40 mmHg when corrected to 28°C) causes cerebrovascular changes (i.e., impaired autoregulation) similar to those changes produced by hypercarbia in awake, normothermic patients.",
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