What does this research mean for the field?

Adding phenylephrine to deeper anesthesia to support blood pressure during carotid endarterectomy increases left ventricular wall stress and results in a threefold higher incidence of myocardial ischemia compared to maintaining blood pressure with light anesthesia alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether anesthetic choice and pharmacologic blood pressure augmentation with phenylephrine influence myocardial ischemia during carotid endarterectomy.

December 1, 1988AnesthesiologyOpen Access

Does Anesthetic Technique Make a Difference? Augmentation of Systolic Blood Pressure during Carotid Endarterectomy

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Carotid endarterectomy (n=60). Intervention: Higher concentration of anesthetic plus phenylephrine vs. Low concentration of anesthetic alone (light anesthesia). Primary outcome: Incidence of myocardial ischemia (threefold greater incidence).

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Key result

Phenylephrine plus higher-dose anesthesia increases myocardial ischemia ~3-fold versus light anesthesia during carotid endarterectomy.

threefold greater incidence
n=60

Why the study?

Does the addition of phenylephrine to higher concentration anesthetics increase the incidence of myocardial ischemia in patients undergoing carotid endarterectomy compared to light anesthesia alone?

Population

60 patients undergoing carotid endarterectomy

Comparison

Higher concentration of anesthetic plus… vs Low concentration of anesthetic alone

Design

RCT, Randomly assigned

Follow-up

Perioperative/postoperative

Authors

JSJ. S. C. SmithUniversity of Hertfordshire MRMichael F. RoizenGeneral / Preventive / Lipids MCMichael K. CahalanJikei University School of Medicine

Discussion

Member takes

Implication

Supports avoiding phenylephrine with higher-concentration anesthesia in carotid endarterectomy; challenges conventional vasopressor strategies.

Key Points

To determine whether anesthetic choice and pharmacologic blood pressure augmentation with phenylephrine influence myocardial ischemia during carotid endarterectomy.
Randomized trial of 60 patients undergoing carotid endarterectomy assigned to halothane or isoflurane (with nitrous oxide) administered at low concentrations alone or higher concentrations supplemented with phenylephrine.
Maintained systolic blood pressure within 20% of baseline ward values and monitored collateral flow via carotid stump pressures.
Evaluated perioperative outcomes using seven-lead electrocardiography, intraoperative echocardiographic wall motion and meridional wall stress analysis, postoperative creatine kinase isoenzymes, and clinical exams.
Patients receiving high-dose anesthesia plus phenylephrine had significantly higher end-systolic meridional wall stress and a threefold greater incidence of myocardial ischemia than those maintained with light anesthesia alone.
Carotid stump pressures were identical across all four anesthetic regimens, and no significant differences in wall stress or myocardial ischemia were observed between halothane and isoflurane.

Study Design

Type

RCT (n=60)

Structured PICO

Does the addition of phenylephrine to higher concentration anesthetics increase the incidence of myocardial ischemia in patients undergoing carotid endarterectomy compared to light anesthesia alone?

Population

60 patients undergoing carotid endarterectomy.

Intervention

Higher concentration of anesthetic (halothane or isoflurane with nitrous oxide) plus phenylephrine to support blood pressure

Comparator

Low concentration of anesthetic (halothane or isoflurane with nitrous oxide) alone

Outcome

Incidence of myocardial ischemiasurrogate

Main Result

Effect estimate: threefold greater incidence

The use of phenylephrine to support blood pressure during carotid endarterectomy under higher concentration anesthesia is associated with a threefold increase in myocardial ischemia compared to light anesthesia alone.

Limitations

Only echocardiograms with normal regional wall motion could be accurately analyzed for wall stress and Vcfc.

Cite This Study

Smith et al. (1988) conducted an RCT in Carotid endarterectomy (n=60). Higher concentration of anesthetic plus phenylephrine vs. Low concentration of anesthetic alone (light anesthesia) was evaluated on Incidence of myocardial ischemia (threefold greater incidence). Adding phenylephrine to a higher concentration of anesthetic resulted in a threefold greater incidence of myocardial ischemia compared to light anesthesia alone during carotid endarterectomy.

synapsesocial.com/papers/6aa576e16b1ae6e96478ea47 https://doi.org/10.1097/00000542-198812000-00008

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Implication

Supports avoiding phenylephrine with higher-concentration anesthesia in carotid endarterectomy; challenges conventional vasopressor strategies.

Does Anesthetic Technique Make a Difference? Augmentation of Systolic Blood Pressure during Carotid Endarterectomy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Does Anesthetic Technique Make a Difference? Augmentation of Systolic Blood Pressure during Carotid Endarterectomy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider