45. EFFICACY OF CONTINUOUS INTRAVENOUS INFUSION OF PHENYLEPHRINE COMBINED WITH NORADRENALINE IN THE TREATMENT OF HYPOTENSION IN PATIENTS UNDERGOING EMERGENCY SURGERY FOR SEVERE TRAUMATIC BRAIN INJURY
Main Article Content
Abstract
Objective: To evaluate the effectiveness of Phenylephrine combined with continuous intravenous infusion of Noradrenaline in treating hypotension in patients with severe traumatic brain injury undergoing emergency surgery.
Methods: The study analyzed articles searched on the electronic databases PubMed, Journals, Neurosurgery, Journal of Critical Care, showing that the combination of Phenylephrine and continuous intravenous infusion of Noradrenaline would be a good choice in anesthesia and resuscitation of patients with severe traumatic brain injury... The combination of Phenylephrine and Noradrenaline increases mean arterial blood pressure, increases cerebral perfusion pressure, thereby improving treatment outcomes for patients with severe traumatic brain injury.
Results: Phenylephrine is an α-adrenergic agonist that increases systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure. Phenylephrine combined with Noradrenaline is a sympathomimetic agonist that acts on both α1-adrenergic receptors and β1-adrenergic receptors, causing vasoconstriction and hypertension, ensuring maintenance of cerebral perfusion pressure in severe traumatic brain injury, reducing the dose of Noradrenaline or Phenylephrine if used alone, reducing treatment costs for patients, but further clinical research is still needed.
Conclusion: Phenylephrine combined with Noradrenaline has vasoconstrictor and blood pressure increasing effects, ensuring maintenance of cerebral perfusion pressure in severe traumatic brain injury.
Article Details
Keywords
Hypotension, severe traumatic brain injury, Phenylephrine, Noradrenaline.
References
[2] Froese L, Dian J, Gomez A, Unger B, Zeiler F.A. Cerebrovascular Response to Phenylephrine in Traumatic Brain Injury: A Scoping Systematic Review of the Human and Animal Literature. Neurotrauma Rep, 2020, 1 (1): 46-62. doi:10.1089/neur.2020.0008
[3] Phenylephrine Hydrochloride Monograph for Professionals. Drugs.com. Accessed September 23, 2024. https://www.drugs.com/monograph/phenylephrine-hydrochloride.html
[4] Olesen J. The effect of intracarotid epinephrine, norepinephrine, and angiotensin on the regional cerebral blood flow in man. Neurology, 1972, 22 (9): 978-978. doi:10.1212/WNL.22.9.978
[5] Greenfield J.C, Tindall G.T. Effect of norepinephrine, epinephrine, and angiotensin on blood flow in the internal carotid artery of man. J Clin Invest, 1968, 47 (7): 1672-1684.
[6] Early Vasopressor Utilization Strategies and Outcomes in Critically III Patients With Severe Traumatic Brain Injury. Anesth Analg, 2022 Dec 1, 135 (6): 1245-1252. doi: 10.1213/ANE.0000000000005949.Epub 2022 Feb 24.
[7] Traumatic brain injury-induced autoregulatory dysfunction. Am J Physiol Heart Circ Physiol, 2016 Nov 1, 311 (5): H1118-H1131. doi:10.1152/ajpheart.00267.2016
[8] Impact of phenylephrine administration on cerebral tissue oxygen saturation and blood volume is modulated by carbon dioxide in anaesthetized patients. Br J Anaesth, 2012 Mar 4, 108 (5): 815-822. doi: 10.1093/bja/aes023
[9] Meng L, Sun Y, Zhao X et al. Effects of phenylephrine on systemic and cerebral circulations in humans: a systematic review with mechanistic explanations. Anaesthesia, 2024, 79 (1): 71-85. doi:10.1111/anae.16172
[10] Lloyd-Donald P, Spencer W, Cheng J et al. In adult patients with severe traumatic brain injury, does the use of norepinephrine for augmenting cerebral perfusion pressure improve neurological outcome? A systematic review. Injury, 2020, 51 (10): 2129-2134. doi:10.1016/j.injury.2020.07.054
[11] Sookplung P, Siriussawakul A, Malakouti A et al. Vasopressor Use and Effect on Blood Pressure After Severe Adult Traumatic Brain Injury. Neurocrit Care, 2011, 15 (1): 46-54. doi:10.1007/s12028-010-9448-9.
[12] Combination of norepinephrine with phenylephrine versus norepinephrine with vasopressin in critically ill patients with septic shock: A retrospective study. Journal of Critical Care, December 2022, volume 72, 154121.