Effects of low-dose epinephrine on cerebral oxygen saturation and awakening time during one-lung ventilation: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Peiyi ,  WEI Wei

Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

WEI Wei, Email: weiw@scu.edu.cn

Keywords：

One-lung ventilation; cerebral oxygen saturation; epinephrine; awakening time

DOI：

10.7507/1007-4848.201704003

Video：

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Objective To evaluate the effects of low-dose epinephrine on cerebral oxygen saturation (rScO₂) and awakening time during one-lung ventilation (OLV) for thoracic surgery. Methods Thirty consecutive patients undergoing lobectomy from March to July 2016 in our hospital were randomly divided into an epinephrine group (n=15, 8 males and 7 females at an average age of 58.70±11.40 years) or a saline group (n=15, 7 males and 8 females at an average age of 57.00±11.40 years). They were continuously infused with 0.01 μg/(kg·min) epinephrine or saline after general induction. Hemodynamics was maintained ±20% of the baseline value. All patients were ventilated by a pressure control mode during OLV with tidal volume of 5-8 ml/kg and end-tidal carbon dioxide tension (EtCO₂) of 35-45 mm Hg. Regional cerebral oxygen saturation (rScO₂) was monitored using near-infrared spectroscopy (NIRS) continuously. Results Compared with the saline group, the epinephrine group had a high rScO₂ during OLV, with a statisitical significance at OLV 40 min and 50 min (67.76%±4.64% vs. 64.08%±3.07%, P=0.016; 67.25%±4.34% vs. 64.20%±3.37%, P=0.040). In addition, the awakening time of patients in the epinephrine group was shorter than that of the saline group (P=0.004), and the awakening time was associated with the duration of low-dose rScO₂ (r=0.374). Conclusion Continuous infusion of 0.01 μg/(kg·min) could improve the rScO₂ during OLV and shorten awakening time in thoracic surgery.

Citation： LI Peiyi, WEI Wei. Effects of low-dose epinephrine on cerebral oxygen saturation and awakening time during one-lung ventilation: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(3): 208-212. doi: 10.7507/1007-4848.201704003 Copy

1.	Jöbsis FF. Non-invasive, infra-red monitoring of cerebral O2 sufficiency, bloodvolume, HbO2-Hb shifts and bloodflow. Acta Neurol Scand Suppl, 1977, 64: 452-453.
2.	Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth, 2009, 103 Suppl 1: i3-i13.
3.	Murkin JM. Cerebral oximetry: monitoring the brain as the index organ. Anesthesiology, 2011, 114(1): 12-13.
4.	Stilo F, Spinelli F, Martelli E, et al. The sensibility and specificity of cerebral oximetry, measured by INVOS - 4100, in patients undergoing carotid endarterectomy compared with awake testing. Minerva Anestesiol, 2012, 78(10): 1126-1135.
5.	Ishikawa S, Lohser J. One-lung ventilation and arterial oxygenation. Curr Opin Anaesthesiol, 2011, 24(1): 24-31.
6.	Kazan R, Bracco D, Hemmerling TM. Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications. Br J Anaesth, 2009, 103(6): 811-816.
7.	Tang L, Kazan R, Taddei R, et al. Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth, 2012, 108(4): 623-629.
8.	Meng L, Cannesson M, Alexander BS, et al. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth, 2011, 107(2): 209-217.
9.	Nissen P, Brassard P, Jørgensen TB, et al. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care, 2010, 12(1): 17-23.
10.	Kurita T, Kawashima S, Morita K, et al. Dobutamine, a β1 adrenoceptor agonist, increases cerebral oxygenation during acute anemia and apneic hypoxia. Neurocrit Care, 2017, 27(3): 420-429.
11.	Choi JW, Joo Ahn H, Yang M, et al. Comparison between phenylephrine and dopamine in maintaining cerebral oxygen saturation in thoracic surgery: a randomized controlled trial. Medicine (Baltimore), 2015, 94(49): e2212.
12.	Bakovic D, Pivac N, Eterovic D, et al. The effects of low-dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets. Clin Physiol Funct Imaging, 2013, 33(1): 30-37.
13.	Hemmerling TM, Bluteau MC, Kazan R, et al. Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry. Br J Anaesth, 2008, 101(6): 870-875.
14.	Sharrock NE, Mineo R, Urquhart B. Hemodynamic response to low-dose epinephrine infusion during hypotensive epidural anesthesia for total hip replacement. Reg Anesth, 1990, 15(6): 295-299.
15.	Oualha M, Urien S, Spreux-Varoquaux O, et al. Pharmacokinetics, hemodynamic and metabolic effects of epinephrine to prevent post-operative low cardiac output syndrome in children. Crit Care, 2014, 18(1): R23.
16.	Henriksen OM, Jensen LT, Krabbe K, et al. Relationship between cardiac function and resting cerebral blood flow: MRI measurements in healthy elderly subjects. Clin Physiol Funct Imaging, 2014, 34(6): 471-477.
17.	Meng L, Hou W, Chui J, et al. Cardiac output and cerebral blood flow: the integrated regulation of brain perfusion in adult humans. Anesthesiology, 2015, 123(5): 1198-1208.
18.	Schramm P, Tzanova I, Hagen F, et al. Cerebral oxygen saturation and cardiac output during anaesthesia in sitting position for neurosurgical procedures: a prospective observational study. Br J Anaesth, 2016, 117(4): 482-488.
19.	Baltanás Rubio P, Peligero Deza J, Gimeno Garcés L, et al. Delayed awakening due to stroke. Rev Esp Anestesiol Reanim, 2016, 63(7): 431.
20.	Shirasaka T, Okada K, Kano H, et al. New indicator of postoperative delayed awakening after total aortic arch replacement. Eur J Cardiothorac Surg, 2015, 47(1): 101-105.

1. Jöbsis FF. Non-invasive, infra-red monitoring of cerebral O2 sufficiency, bloodvolume, HbO2-Hb shifts and bloodflow. Acta Neurol Scand Suppl, 1977, 64: 452-453.
2. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth, 2009, 103 Suppl 1: i3-i13.
3. Murkin JM. Cerebral oximetry: monitoring the brain as the index organ. Anesthesiology, 2011, 114(1): 12-13.
4. Stilo F, Spinelli F, Martelli E, et al. The sensibility and specificity of cerebral oximetry, measured by INVOS - 4100, in patients undergoing carotid endarterectomy compared with awake testing. Minerva Anestesiol, 2012, 78(10): 1126-1135.
5. Ishikawa S, Lohser J. One-lung ventilation and arterial oxygenation. Curr Opin Anaesthesiol, 2011, 24(1): 24-31.
6. Kazan R, Bracco D, Hemmerling TM. Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications. Br J Anaesth, 2009, 103(6): 811-816.
7. Tang L, Kazan R, Taddei R, et al. Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth, 2012, 108(4): 623-629.
8. Meng L, Cannesson M, Alexander BS, et al. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth, 2011, 107(2): 209-217.
9. Nissen P, Brassard P, Jørgensen TB, et al. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care, 2010, 12(1): 17-23.
10. Kurita T, Kawashima S, Morita K, et al. Dobutamine, a β1 adrenoceptor agonist, increases cerebral oxygenation during acute anemia and apneic hypoxia. Neurocrit Care, 2017, 27(3): 420-429.
11. Choi JW, Joo Ahn H, Yang M, et al. Comparison between phenylephrine and dopamine in maintaining cerebral oxygen saturation in thoracic surgery: a randomized controlled trial. Medicine (Baltimore), 2015, 94(49): e2212.
12. Bakovic D, Pivac N, Eterovic D, et al. The effects of low-dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets. Clin Physiol Funct Imaging, 2013, 33(1): 30-37.
13. Hemmerling TM, Bluteau MC, Kazan R, et al. Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry. Br J Anaesth, 2008, 101(6): 870-875.
14. Sharrock NE, Mineo R, Urquhart B. Hemodynamic response to low-dose epinephrine infusion during hypotensive epidural anesthesia for total hip replacement. Reg Anesth, 1990, 15(6): 295-299.
15. Oualha M, Urien S, Spreux-Varoquaux O, et al. Pharmacokinetics, hemodynamic and metabolic effects of epinephrine to prevent post-operative low cardiac output syndrome in children. Crit Care, 2014, 18(1): R23.
16. Henriksen OM, Jensen LT, Krabbe K, et al. Relationship between cardiac function and resting cerebral blood flow: MRI measurements in healthy elderly subjects. Clin Physiol Funct Imaging, 2014, 34(6): 471-477.
17. Meng L, Hou W, Chui J, et al. Cardiac output and cerebral blood flow: the integrated regulation of brain perfusion in adult humans. Anesthesiology, 2015, 123(5): 1198-1208.
18. Schramm P, Tzanova I, Hagen F, et al. Cerebral oxygen saturation and cardiac output during anaesthesia in sitting position for neurosurgical procedures: a prospective observational study. Br J Anaesth, 2016, 117(4): 482-488.
19. Baltanás Rubio P, Peligero Deza J, Gimeno Garcés L, et al. Delayed awakening due to stroke. Rev Esp Anestesiol Reanim, 2016, 63(7): 431.
20. Shirasaka T, Okada K, Kano H, et al. New indicator of postoperative delayed awakening after total aortic arch replacement. Eur J Cardiothorac Surg, 2015, 47(1): 101-105.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effects of low-dose epinephrine on cerebral oxygen saturation and awakening time during one-lung ventilation: A randomized controlled trial

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