Episode 19: Push Dose Vasopressors in Anesthesia

Anesthesia induced hypotension is commonly treated with push dose vasopressors. Today Jeremy & Sass dive into what the evidence is showing us about the use of phenylephrine, ephedrine, and norepinephrine IV bolus doses. We talk about cerebral oxygen concentrations and cardiac output when administering these vasopressors, and ultimately ask ourselves…should we be less pushy?
References

1. Kee W, et al. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015 Apr;122(4):736-45. 
2. Larson S, et al. Effect of phenylephrine on cerebral oxygen saturation and cardiac output in adults when used to treat intraoperative hypotension: a systematic review. BI Evid Synth. 2020 Sep 15;19(1):34-58. 
3. Meng L,et al. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth. 2011 Aug; 107(2): 209–217.  
4. Mohta M, et al. Comparison of the potency of phenylephrine and norepinephrine bolus doses used to treat post-spinal hypotension during elective caesarean section. Int J Obstet Anesth. 2019 May;38:25-31. 
5. Nissen P, et al. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care. 2010 Feb;12(1):17-23. 
6. Pelaez A, et al. Effect of adrenergic agonists on coronary blood flow: a laboratory study in healthy volunteers. Physiol Rep. 2016 May;4(10):e12806. 
7. Pancaro C, et al. Risk of Major Complications After Perioperative Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study. Anesth Analg. 2020;131(4):1060-1065. 
8. Sharkey  A. Comparison of Intermittent Intravenous Boluses of Phenylephrine and Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean Deliveries: Randomized Controlled Trial. Anesth Analg. 2019 Nov;129(5):1312-1318. 
9. Simons C. The Safety and Efficacy of Peripherally Administered Norepinephrine during the Perioperative Period. AANA J. 2022;90(5):387-395.
10. Thiele R, et al. The physiologic implications of isolated alpha(1) adrenergic stimulation. Anesth Analg. 2011 Aug;113(2):284-96. 
11. Vallee F, et al. Norepinephrine reduces arterial compliance less than phenylephrine when treating general anesthesia-induced arterial hypotension. Acta Anaesthesiol Scand. 2017 Jul;61(6):590-600. 

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