Role of Vasopressor Administration in Patients with Acute Neurologic Injury

Muzevich, Katie M.; Voils, Stacy A.

doi:10.1007/s12028-009-9214-z

Cited by 23 publications

(12 citation statements)

References 45 publications

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“…Unfortunately, given the absence of a control group, whether aggressive resuscitation improves neurological outcomes remains unproven. Despite the paucity of supporting evidence [10], guidelines issued by the Consortium for Spinal Cord Medicine and others [9][10][11][12] recommend that MABP be kept above 85 mmHg for at least 1 week after SCI. Because the heart receives its sympathetic supply from T1-T4, the use of inotropic and chronotropic vasoactive agents such as NE is recommended in patients with cervical and upper thoracic SCI.…”

Section: Discussionmentioning

confidence: 99%

“…A widely recommended method for increasing SCBF consists in maintaining the mean arterial blood pressure (MABP) above 85 mmHg for 1 week after the injury. However, published evidence supporting this recommendation is scant [9][10][11][12]. All the clinical studies were level III or IV and, for ethical reasons, none included a control group.…”

Section: Introductionmentioning

confidence: 99%

“…To maintain MABP above 85 mmHg after SCI, norepinephrine (NE) is considered a vasopressor of choice [10,11]. However, we are aware of no experimental studies assessing the effect of NE on SCBF or hemorrhage size.…”

Section: Introductionmentioning

confidence: 99%

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Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury

Soubeyrand

Dubory

Laemmel³

et al. 2013

Eur Spine J

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Purpose In the acute phase of spinal cord injury (SCI), ischemia and parenchymal hemorrhage are believed to worsen the primary lesions induced by mechanical trauma. To minimize ischemia, keeping the mean arterial blood pressure above 85 mmHg for at least 1 week is recommended, and norepinephrine is frequently administered to achieve this goal. However, no experimental study has assessed the effect of norepinephrine on spinal cord blood flow (SCBF) and parenchymal hemorrhage size. We have assessed the effect of norepinephrine on SCBF and parenchymal hemorrhage size within the first hour after experimental SCI. Methods A total of 38 animals were included in four groups according to whether SCI was induced and norepinephrine injected. SCI was induced at level Th10 by dropping a 10-g weight from a height of 10 cm. Each experiment lasted 60 min. Norepinephrine was started 15 min after the trauma. SCBF was measured in the ischemic penumbra zone surrounding the trauma epicenter using contrast-enhanced ultrasonography. Hemorrhage size was measured repeatedly on parasagittal B-mode ultrasonography slices.Results SCI was associated with significant decreases in SCBF (P = 0.0002). Norepinephrine infusion did not significantly modify SCBF. Parenchymal hemorrhage size was significantly greater in the animals given norepinephrine (P = 0.0002). Conclusion In the rat, after a severe SCI at the Th10 level, injection of norepinephrine 15 min after SCI does not modify SCBF and increases the size of the parenchymal hemorrhage.Keywords Spinal cord injury Á Spinal cord blood flow Á Norepinephrine Á Contrast-enhanced ultrasonography A. Dubory and E. Laemmel have equally contributed to this work. E. Vicaut and J. Duranteau have equally contributed to this work.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury

Soubeyrand

Dubory

Laemmel³

et al. 2013

Eur Spine J

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“…In TBI, intravenous phenylephrine has been reported to be the most frequently administered intraoperative vasopressor [12]. Despite this practice, available evidence suggests that vasopressors with inotropic effects such as norepinephrine might be preferable as the vasopressor of choice in acute neurologic injury [13]. This case documents cardiac dysfunction acutely after TBI and suggests that anesthesiologists should consider point of care evaluation of cardiac function in their decision of vasopressor choice acutely after TBI.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Dysfunction in Acute Traumatic Brain Injury Relieved by Surgical Decompression

Krishnamoorthy

Sharma

Prathep

et al. 2013

Case Reports in Anesthesiology

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Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America. After a primary TBI, secondary brain insults can predispose patients to a worse outcome. One of the earliest secondary insults encountered during the perioperative period is hypotension, which has been directly linked to both mortality and poor disposition after TBI. Despite this, it has been shown that hypotension commonly occurs during surgery for TBI. We present a case of intraoperative hypotension during surgery for TBI, where the use of transthoracic echocardiography had significant diagnostic and therapeutic implications for the management of our patient. We then discuss the issue of cardiac dysfunction after brain injury and the implications that echocardiography may have in the management of this vulnerable patient population.

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“…Therefore, aggressive fluid management with high-normal MAP (85-90 mmHg) for 7 days is safe, improves spinal cord perfusion and may enhance neurological outcome [101]. In persisting hypotension, despite aggressive fluid resuscitation, norepinephrine is the vasopressor of choice to elevate blood pressure [102]. Due to overwhelming fluid resuscitation in vasoplegia, serious complications, such as pulmonary edema and hyponatremia, can occur [103].…”

Section: Spine Injurymentioning

confidence: 99%

Surgical intensive care unit—the trauma surgery perspective

Kleber

Schaser

Haas

2011

Langenbecks Arch Surg

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Role of Vasopressor Administration in Patients with Acute Neurologic Injury

Abstract: Although high-quality clinical data are scarce, the available evidence suggests that norepinephrine should be considered as the vasopressor of choice when blood pressure elevation is indicated in patients with acute neurologic injury.

Cited by 23 publications

References 45 publications

Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury

Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury

Myocardial Dysfunction in Acute Traumatic Brain Injury Relieved by Surgical Decompression

Surgical intensive care unit—the trauma surgery perspective

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