Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

Hagen, Ove Andreas; Høiseth, Lars Øivind; Roslin, André; Landsverk, Svein Aslak; Woldbæk, Per Reidar; Pripp, Are Hugo; Hanoa, Rolf; Kirkebøen, Knut Arvid

doi:10.1053/j.jvca.2015.12.015

Cited by 12 publications

(10 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A possible confounder leading to this trend could be the use of norepinephrine. Norepinephrine was given more frequently to patients with POCD and this may have caused a decrease in rScO 2 , 29,34 as norepinephrine is known to have an impact on NIRS measurements, probably attributable to vasoconstriction in extracranial tissue. 35 In addition, we have previously shown, that the HMAP group had more severe cerebral desaturation compared with the LMAP group 36 and this may be the reason for the significant finding in the HMAP group in the present study.…”

Section: Postoperative Cognitive Dysfunction At Dischargementioning

confidence: 99%

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

Holmgaard

Vedel

Rasmussen

et al. 2019

British Journal of Anaesthesia

View full text Add to dashboard Cite

Background: Postoperative cognitive dysfunction (POCD) occurs commonly after cardiac surgery. Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rScO 2) in order to minimise the occurrence of POCD by applying dedicated interventions when rScO 2 decreases. However, the association between rScO 2 intraoperatively and POCD has not been clarified. Methods: This is a secondary analysis of a randomised trial with physician-blinded NIRS monitoring and cognitive testing at discharge from hospital and at 3 months after surgery. The association between intraoperative rScO 2 values and POCD at discharge from hospital and at 3 months after surgery was investigated. The prespecified candidate predictive variable of interest was cumulative time during surgery with rScO 2 !10% below its preoperative value. Results: One hundred and fifty-three patients had complete NIRS data and neurocognitive assessments at discharge, and 44 of these patients (29%) had POCD. At 3 months, 148 patients had complete data, and 12 (8%) of these patients had POCD. The median time with rScO 2 >10% below preoperative values did not differ for patients with and without POCD at discharge (difference¼0.0 min; Hodges-Lehmann 95% confidence interval, À3.11e1.47, P¼0.88). Other rScO 2 time thresholds that were assessed were also not significantly different between those with and without POCD at discharge. This applied both to absolute rScO 2 values and relative changes from preoperative values. Similar results were found in relation to POCD at 3 months. Conclusions: No significant association was found between intraoperative rScO 2 values and POCD. These findings bring into question the rationale for attempting to avoid decreases in rScO 2 if the goal is to prevent POCD. Clinical trial registration: NCT 02185885.

show abstract

Section: Postoperative Cognitive Dysfunction At Dischargementioning

confidence: 99%

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

Holmgaard

Vedel

Rasmussen

et al. 2019

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…In addition, gastrointestinal mucosal perfusion seems unaffected by norepinephrine after cardiac surgery in adults . Likewise, cerebral oxygen saturation seems unaffected by this agent during cardiopulmonary bypass in adults . With respect to the second concern, vasoconstriction is enforced only to the extent of achieving minimum acceptable physiological perfusion pressures, that is, the infusion rate of norepinephrine is meticulously adjusted and calibrated, using syringe drivers that allow adjustments of 0.1 mL/h, to achieve precisely those pressures and no more.…”

Section: Discussionmentioning

confidence: 99%

Improvement in perioperative care in pediatric cardiac surgery by shifting the primary focus of treatment from cardiac output to perfusion pressure: Are beta stimulants still needed?

Hosseinpour¹,

Steenberghe²,

Bernath

et al. 2017

Congenital Heart Disease

View full text Add to dashboard Cite

Objective: An important aspect of perioperative care in pediatric cardiac surgery is maintenance of optimal hemodynamic status using vasoactive/inotropic agents. Conventionally, this has focused on maintenance of cardiac output rather than perfusion pressure. However, this approach has been abandoned in our center in favor of one focusing primarily on perfusion pressure, which is presented here and compared to the conventional approach.

show abstract

“…There was no significant association between any neuropsychological test outcomes and the development of POCD. However, a potential confounder may be the more frequent use of noradrenaline in patients with POCD, given noradrenaline is associated with decreased rSO2 ( 111 , 112 ). Rogers et al ( 113 ) aimed to determine whether a maintaining an absolute rSO2 of >50% or >70% compared to baseline would reduce peri-operative end-organ damage.…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

View full text Add to dashboard Cite

Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015–present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.

show abstract

Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

Cited by 12 publications

References 29 publications

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

The association between postoperative cognitive dysfunction and cerebral oximetry during cardiac surgery: a secondary analysis of a randomised trial

Improvement in perioperative care in pediatric cardiac surgery by shifting the primary focus of treatment from cardiac output to perfusion pressure: Are beta stimulants still needed?

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Contact Info

Product

Resources

About