Assessment of central hemodynamic effects of phenylephrine: an animal experiment

TY - JOUR

T1 - Assessment of central hemodynamic effects of phenylephrine: an animal experiment

AU - Wodack, Karin H

AU - Gräßler, Michael Florian

AU - Nishimoto, Sarah A

AU - Behem, Christoph R

AU - Pinnschmidt, Hans O

AU - Punke, Mark A

AU - Monge-García, M Ignacio

AU - Trepte, Constantin J C

AU - Reuter, Daniel A

PY - 2019/6

Y1 - 2019/6

N2 - Phenylephrine is an α1-adrenergic receptor agonist widely used to treat perioperative hypotension. Its other hemodynamic effects, in particular on preload and contractility, remain controversial. We, therefore, investigated the effect of continuously applied phenylephrine on central hemodynamics in eight mechanically ventilated domestic pigs. Mean arterial pressure (MAP) was increased in steps by 50%, and 100% using phenylephrine. Besides stroke volume (SV), cardiac output (CO), and MAP, mean systemic vascular resistance (SVR) and dynamic arterial elastance (Eadyn) were assessed for characterization of afterload. Changes in preload were assessed by central venous pressure (CVP), global end-diastolic volume (GEDV), mean systemic filling pressure analog (Pmsfa), pulse pressure variation (PPV), and stroke volume variation (SVV). Further, cardiac function index (CFI), global ejection fraction and dPmax were measured as markers of preload dependent contractility. MAP, SV, and CO significantly increased following both interventions, as did SVR. In contrast, Eadyn did not show significant changes. Although the volumetric preload variable GEDV increased after the first step of phenylephrine, this was not reflected by significant changes in CVP or Pmsfa. CFI and dPmax significantly increased after both steps. Phenylephrine does not only affect cardiac afterload, but also increases effective preload. In contrast to CVP and Pmsfa, this effect can be monitored by GEDV. Further, phenylephrine affects contractility.

AB - Phenylephrine is an α1-adrenergic receptor agonist widely used to treat perioperative hypotension. Its other hemodynamic effects, in particular on preload and contractility, remain controversial. We, therefore, investigated the effect of continuously applied phenylephrine on central hemodynamics in eight mechanically ventilated domestic pigs. Mean arterial pressure (MAP) was increased in steps by 50%, and 100% using phenylephrine. Besides stroke volume (SV), cardiac output (CO), and MAP, mean systemic vascular resistance (SVR) and dynamic arterial elastance (Eadyn) were assessed for characterization of afterload. Changes in preload were assessed by central venous pressure (CVP), global end-diastolic volume (GEDV), mean systemic filling pressure analog (Pmsfa), pulse pressure variation (PPV), and stroke volume variation (SVV). Further, cardiac function index (CFI), global ejection fraction and dPmax were measured as markers of preload dependent contractility. MAP, SV, and CO significantly increased following both interventions, as did SVR. In contrast, Eadyn did not show significant changes. Although the volumetric preload variable GEDV increased after the first step of phenylephrine, this was not reflected by significant changes in CVP or Pmsfa. CFI and dPmax significantly increased after both steps. Phenylephrine does not only affect cardiac afterload, but also increases effective preload. In contrast to CVP and Pmsfa, this effect can be monitored by GEDV. Further, phenylephrine affects contractility.

KW - Animals

KW - Arterial Pressure

KW - Blood Flow Velocity

KW - Blood Pressure

KW - Cardiac Output

KW - Central Venous Pressure

KW - Diastole

KW - Disease Models, Animal

KW - Hemodynamics

KW - Monitoring, Physiologic

KW - Phenylephrine/pharmacology

KW - Receptors, Adrenergic, alpha-1/metabolism

KW - Stroke Volume

KW - Swine

KW - Vascular Resistance

U2 - 10.1007/s10877-018-0204-6

DO - 10.1007/s10877-018-0204-6

M3 - SCORING: Journal article

C2 - 30264219

VL - 33

SP - 377

EP - 384

JO - J CLIN MONIT COMPUT

JF - J CLIN MONIT COMPUT

SN - 1387-1307

IS - 3

ER -