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April 26, 2011Anesthesia & Analgesia

The Clinical Implications of Isolated Alpha1 Adrenergic Stimulation

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Why the study?

In which clinical settings is isolated alpha1 adrenergic stimulation with phenylephrine a rational pharmacologic choice for treating hypotension?

Population

Patients with hypotension in various clinical settings including severe aortic stenosis, decompensated…

Design

Review

Authors

RTRobert H. ThieleUniversity of Virginia Health SystemENEdward C. NemergutWest Virginia UniversityCLCarl LynchUniversity of Virginia Health System

Discussion

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Implication

May guide vasopressor choice in aortic stenosis, TOF, and cesarean hypotension; leaves open need for RCTs versus alternatives.

Structured PICO

In which clinical settings is isolated alpha1 adrenergic stimulation with phenylephrine a rational pharmacologic choice for treating hypotension?

P
Population
Patients with hypotension in various clinical settings including severe aortic stenosis, decompensated tetralogy of Fallot, septic shock, traumatic brain injury, vasospasm status-postsubarachnoid hemorrhage, and cesarean delivery
I
Intervention
Phenylephrine (and methoxamine) / isolated alpha1 adrenergic stimulation
O
Outcome
Physiologic and clinical effects (cardiac afterload, venous compliance, renal blood flow, regional vs global effects)

Phenylephrine is beneficial for hypotension in specific conditions like critical aortic stenosis and tetralogy of Fallot, but its global reduction in cardiac output makes alternative vasopressors preferable in other states.

Cite This Study

Thiele et al. (2011) studied this question.

synapsesocial.com/papers/6a6f990035aa2c282ce0f107https://doi.org/10.1213/ane.0b013e3182120ca5
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Effect of Phenylephrine Bolus Administration on Left Ventricular Function During Isoflurane-Induced Hypotension1993 · 34 citations
  2. 2Intraoperative Tachycardia and Hypertension Are Independently Associated with Adverse Outcome in Noncardiac Surgery of Long Duration2002 · 198 citations
  3. 3Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock2001 · 10,844 citations
  4. 4Effects of Acutely Increasing Systemic Vascular Resistance on Oxygen Tension in Tetralogy of Fallot1976 · 23 citations
  5. 5COMPARISON OF THE EFFECTS OF SYMPATHOMIMETIC AMINES UPON VENOUS AND TOTAL VASCULAR RESISTANCE IN THE FORELEG OF THE DOG1964 · 13 citations