Cafedrine/theodrenaline induced a 10% increase in mean arterial pressure significantly faster in women (7.2 minutes) than in men (8.6 minutes) during anaesthesia.
Observational (n=353)
No
Does cafedrine/theodrenaline effectively restore mean arterial pressure during anaesthesia-induced hypotension?
Cafedrine/theodrenaline rapidly restores mean arterial pressure during anaesthesia, though its effectiveness is slightly reduced in men, patients with heart failure, and those on beta-blockers.
Absolute Event Rate: 7.2% vs 8.6%
p-value: p=0.018
BACKGROUND: Hypotensive states that require fast stabilisation of blood pressure can occur during anaesthesia. In 1963, the 20:1 mixture of cafedrine/theodrenaline (Akrinor) was introduced in Germany for use in anaesthesia and emergency medicine in the first-line management of hypotensive states. Though on the market for many years, few pharmacodynamic data are available on this combination net beta-mimetic agent. AIM: This study aimed to examine the drug combination in real-life clinical practice and recorded time to 10 % mean arterial blood pressure (MAP) increase and heart rate. Furthermore, potential factors that influence drug effectiveness under anaesthesia were assessed. METHODS: Data were collected within a standardised anaesthesia protocol. A total of 353 consecutive patients (female/male = 149/204) who received cafedrine/theodrenaline after a drop in MAP ≥ 5% were included in the study. The time to 10 % increase in MAP, dosage of cafedrine/theodrenaline, volume loading, blood pressure and heart rate were monitored over time. RESULTS: Patients were a mean (standard deviation) of 64.4 ± 15.1 years old with a baseline MAP of 82 ± 14 mmHg, which dropped to a mean of 63 ± 10 mmHg during anaesthesia without gender differences. Cafedrine/theodrenaline (1.27 ± 1.0 mg/kg; 64 ± 50 µg/kg) significantly increased MAP (p < 0.001) by 11 ± 16 mmHg within 5 min, reaching peak values within 17.4 ± 9.0 min. Heart rate was not affected in a clinically significant manner. Cafedrine/theodrenaline induced a 10% MAP increase after 7.2 ± 4.6 min (women) and after 8.6 ± 6.3 min (men) (p = 0.018). Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure 1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline) compared with healthy patients 1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline) (p = 0.005). Concomitant medication with beta-blocking agents significantly prolonged the time to 10 % MAP increase 9.0 ± 7.0 vs. 7.3 ± 4.3 min (p = 0.008). CONCLUSION: Cafedrine/theodrenaline quickly restores MAP during anaesthesia. Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect. Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.
Heller et al. (Sun,) conducted a observational in Hypotension during anaesthesia (n=353). Cafedrine/theodrenaline (Women) vs. Men was evaluated on Time to 10% increase in mean arterial pressure (minutes) (p=0.018). Cafedrine/theodrenaline induced a 10% increase in mean arterial pressure significantly faster in women (7.2 minutes) than in men (8.6 minutes) during anaesthesia.