December 1, 2015MedicineOpen Access

Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral Oxygen Saturation in Thoracic Surgery

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Why the study?

Does dopamine improve regional cerebral oxygen saturation compared to phenylephrine in patients undergoing thoracic surgery with one-lung ventilation?

Population

50 adults undergoing elective thoracic surgery for lung cancer with ASA physical status I-III, presenting…

Comparison

Dopamine continuous intravenous infusion… vs Phenylephrine continuous intravenous infusion…

Design

RCT, 1:1 allocation, randomized using a computerized random number generator…

Follow-up

Intraoperative and up to 48 hours postoperatively

Authors

JCJi Won ChoiKumoh National Institute of Technology HAHyun Joo AhnSamsung Medical Center MYMikyung YangTaiwan Livestock Research Institute

Discussion

Member takes

Implication

Dopamine may be preferred over phenylephrine to preserve cerebral oxygenation during thoracic OLV; extends RCT evidence on vasoactive selection.

Structured PICO

Does dopamine improve regional cerebral oxygen saturation compared to phenylephrine in patients undergoing thoracic surgery with one-lung ventilation?

Population

50 adults (age >18 years) undergoing elective thoracic surgery for lung cancer (lobectomy or bilobectomy) with ASA physical status I-III, presenting with at least a 20% decrease in mean arterial pressure during anesthesia. Mean age ~70 years, 76% male, based in a tertiary care academic center in the Republic of Korea.

Intervention

Dopamine continuous intravenous infusion, started at 5 mcg/kg/min and adjusted to maintain mean arterial pressure within 20% of baseline during surgery.

Comparator

Phenylephrine continuous intravenous infusion, started at 1 mcg/kg/min and adjusted to maintain mean arterial pressure within 20% of baseline during surgery.

Outcome

Regional cerebral oxygen saturation (rScO2) during one-lung ventilation (OLV), measured by near-infrared spectroscopy.surrogate

Dopamine is superior to phenylephrine in maintaining cerebral oxygenation during one-lung ventilation in thoracic surgery, likely due to its ability to maintain higher cardiac output.

Limitations

Monocentric approach of hemodynamic control, which may not reflect multimodal clinical practice.
Did not measure cerebral blood flow directly, only oxygenation.
Measured cardiac output using an esophageal Doppler, which may be less accurate under the influence of vasopressors.
Phenylephrine may constrict scalp vessels and result in the reduction of rScO2 measured by NIRS.

Cite This Study

Choi et al. (2015) studied this question.

synapsesocial.com/papers/6a6f997835aa2c282ce0f16f https://doi.org/10.1097/md.0000000000002212

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Implication

Dopamine may be preferred over phenylephrine to preserve cerebral oxygenation during thoracic OLV; extends RCT evidence on vasoactive selection.

Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral Oxygen Saturation in Thoracic Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral Oxygen Saturation in Thoracic Surgery

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider