Key result
Cafedrine/theodrenaline rapidly reverses hypotension by increasing stroke volume and cardiac output without raising vascular resistance.
Why the study?
Although cafedrine/theodrenaline has been widely used in Germany since 1963 for hypotensive states, few studies exist and much data are only available in German.
Systematic Review
Supports perioperative and obstetric use; leaves open need for contemporary RCTs versus alternatives.
A 20:1 combination of cafedrine:theodrenaline (Akrinor®) is widely used in Germany for the treatment of hypotensive states during anesthesia and in emergency medicine. Although this drug formulation has been available since 1963, there are few studies relating to its use and many of the data are only available in German. In this article, we summarize the available data and propose mechanisms for the effects of cafedrine/theodrenaline on cardiac muscle cells and vascular smooth muscle cells. Cafedrine/theodrenaline leads to a rapid increase in mean arterial pressure that is characterized by increased cardiac preload, stroke volume, and cardiac output. Systemic vascular resistance and heart rate remain mostly unchanged. Factors which impact the effects of cafedrine/theodrenaline are gender, high arterial pressure at baseline, use of β-blockers, and heart failure. Importantly, the drug is frequently used in obstetric anesthesia without detrimental effects on umbilical cord pH or APGAR score.
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Bein et al. (2017) conducted a systematic review in Arterial hypotension. Cafedrine/Theodrenaline (20:1) was evaluated. Cafedrine/theodrenaline effectively manages arterial hypotension by rapidly increasing mean arterial pressure through increased cardiac preload, stroke volume, and cardiac output, without significantly altering systemic vascular resistance or heart rate.