Background anaesthetic agents do not influence the impact of arginine vasopressin on haemodynamic states and cerebral oxygenation during shoulder surgery in the beach chair position: a prospective, single-blind studyReportar como inadecuado




Background anaesthetic agents do not influence the impact of arginine vasopressin on haemodynamic states and cerebral oxygenation during shoulder surgery in the beach chair position: a prospective, single-blind study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Anesthesiology

, 17:73

General pharmacology and pharmacokinetics

Abstract

BackgroundAdministration of arginine vasopressin AVP is associated with reducing jugular venous SjvO2 and regional cerebral rScO2 oxygen saturation under propofol-remifentanil P-R anaesthesia. We determined whether background anaesthetics modulate the effect of AVP on cerebral oxygenation and haemodynamics.

MethodsWe randomly allocated 60 adult patients scheduled for shoulder surgery in the beach chair position BCP into 4 groups, to receive either an intravenous bolus of saline groups PR-S and SN-S or 0.05 U-kg AVP groups PR-AVP and SN-AVP under P-R or sevoflurane-nitrous oxide S-N anaesthesia n = 15 each. Haemodynamic variables, SjvO2 and rScO2 were measured.

ResultsAVP significantly increased mean arterial blood pressure MAP and decreased rScO2 in either anaesthetic group. AVP also decreased SjvO2 in the P-R groups but not in the S-N groups. The AVP-treated groups showed higher MAP and cerebral desaturation >20% rScO2 decrease from baseline, along with lower HR and rScO2 in the BCP than those in the saline-treated groups. In contrast, AVP did not affect SjvO2 values or the incidence of SjvO2 < 50%. Baseline SjvO2 was lower and the magnitude of its reduction in the BCP was greater in the PR-AVP group than in the SN-AVP group, and the lowest SjvO2 values were 37 ± 6 and 57 ± 8%, respectively P < 0.001.

ConclusionsThe choice of anaesthetic regimen did not affect cerebral oxygenation or haemodynamics of AVP in the BCP. However, the negative effect of AVP on cerebral oxygenation should be considered, especially under P-R anaesthesia.

Trial registrationClinicalTrials.gov identifier: NCT01687894, registered on September 18, 2012.

KeywordsAnaesthetic Arginine vasopressin Beach chair position Cerebral oxygenation Haemodynamics AbbreviationsACEIsAngiotensin converting enzyme inhibitors

AIIRAsAngiotensin II receptor antagonists

AVPArginine vasopressin

BCPBeach chair position

CBFCerebral blood flow

CPPCerebral perfusion pressure

HRheart rate

MAPMean arterial pressure

N2ONitrous oxide

NIRSNear-infrared spectroscopy

RASRenin-angiotensin system

rScO2Regional cerebral tissue oxygen saturation

SjvO2Jugular venous oxygen saturation





Autor: Eun-A Jang - Ji-A Song - Ji Youn Shin - Jae Joon Yoon - Kyung Yeon Yoo - Seongtae Jeong

Fuente: https://link.springer.com/







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