Arterial Hypotension Clinical Trial
Official title:
Comparison of the Hemodynamic Effects of Phenylephrine and Norepinephrine in Patients Undergoing Deep Inferior Epigastric Perforator (DIEP) Flap Surgery.
Induction of general anesthesia often induces a decrease in the mean arterial blood pressure
(MAP) caused by arterial and venous dilatation. Fluid administration is conventionally used
to increase the patient's total blood volume, but is often associated with multiple adverse
events such as postoperative edema.
Arterial hypotension can also be treated by vasopressor agents such as norepinephrine and
phenylephrine which mainly increase the blood pressure by arterial vasoconstriction.
Compared to phenylephrine, norepinephrine has a shorter half-life (2 - 3 minutes) and
improves the MAP by increase in cardiac contractility. In a recent study at our department it
was demonstrated that besides arterial vasoconstriction, phenylephrine also improves venous
return and cardiac output by venous vasoconstriction.
The aim of this study is to compare the hemodynamic effects of both vasopressor agents in
patients undergoing deep inferior epigastric perforators (DIEP) flap surgery. If significant
differences between both agents are demonstrated, these findings can provide an important
basis for future recommendations.
In consecutive patients scheduled for DIEP flap surgery, all hemodynamic and respiratory
variables are recorded electronically for subsequent off line analysis.
A systolic blood pressure of minimal 100 mmHg will be maintained during surgery by
optimization of the cardiac preload and titrated norepinephrine (1.5 µg/kg/h) or
phenylephrine (15 µg/kg/h) administration. Cardiac preload optimization will be based on
pulse pressure variation (PPV) measurement, which is calculated by pulse contour analysis of
the radial arterial pressure curve. Following the international goal-directed fluid therapy
guidelines, plasmalyte will be administrated if the PPV>11%.
The tricuspid annular plane systolic excursion (TAPSE) will be measured by transthoracic
echocardiography (TTE) to evaluate the inotropic effect of norepinephrine and phenylephrine.
In addition, TTE will be used to measure the cardiac output to calibrate the PPV
measurements.
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