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Assessment of central hemodynamic effects of phenylephrine: an animal experiment

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Abstract

Phenylephrine is an α1-adrenergic receptor agonist widely used to treat perioperative hypotension. Its other hemodynamic effects, in particular on preload and contractility, remain controversial. We, therefore, investigated the effect of continuously applied phenylephrine on central hemodynamics in eight mechanically ventilated domestic pigs. Mean arterial pressure (MAP) was increased in steps by 50%, and 100% using phenylephrine. Besides stroke volume (SV), cardiac output (CO), and MAP, mean systemic vascular resistance (SVR) and dynamic arterial elastance (Eadyn) were assessed for characterization of afterload. Changes in preload were assessed by central venous pressure (CVP), global end-diastolic volume (GEDV), mean systemic filling pressure analog (Pmsfa), pulse pressure variation (PPV), and stroke volume variation (SVV). Further, cardiac function index (CFI), global ejection fraction and dPmax were measured as markers of preload dependent contractility. MAP, SV, and CO significantly increased following both interventions, as did SVR. In contrast, Eadyn did not show significant changes. Although the volumetric preload variable GEDV increased after the first step of phenylephrine, this was not reflected by significant changes in CVP or Pmsfa. CFI and dPmax significantly increased after both steps. Phenylephrine does not only affect cardiac afterload, but also increases effective preload. In contrast to CVP and Pmsfa, this effect can be monitored by GEDV. Further, phenylephrine affects contractility.

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Acknowledgements

We would like to thank the staffs of the animal research laboratory for their support with the study.

Funding

This work was supported only by departmental funds of the Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

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Authors and Affiliations

  1. Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Karin H. Wodack, Michael F. Graessler, Sarah A. Nishimoto, Christoph R. Behem, Mark A. Punke & Constantin J. C. Trepte

  2. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Hans O. Pinnschmidt

  3. Unidad de Cuidados Intensivos, Hospital SAS de Jerez, Jerez de La Frontera, Spain

    M. Ignacio Monge-García

  4. Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany

    Daniel A. Reuter

Authors
  1. Karin H. Wodack
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  2. Michael F. Graessler
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  3. Sarah A. Nishimoto
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  4. Christoph R. Behem
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  7. M. Ignacio Monge-García
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  8. Constantin J. C. Trepte
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Contributions

KHW: study concept and design, acquisition, analysis and interpretation of data, draft of the manuscript, statistical analysis. MFG, SAN: acquisition, analysis and interpretation of data, critical revision of the manuscript for important intellectual content. CRB, MAP, MIMG: interpretation of data, critical revision of the manuscript for important intellectual content. HOP: statistical analysis, interpretation of data, critical revision of the manuscript for important intellectual content. CJCT, DAR: study concept and design, interpretation of data, critical revision of the manuscript for important intellectual content, study supervision.

Corresponding author

Correspondence to Karin H. Wodack.

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Conflict of interest

DAR provided scientific advice for Pulsion/Getinge. MIMG is consultant for Edwards Lifesciences. All other authors declare no conflicts of interest.

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Wodack, K.H., Graessler, M.F., Nishimoto, S.A. et al. Assessment of central hemodynamic effects of phenylephrine: an animal experiment. J Clin Monit Comput 33, 377–384 (2019). https://doi.org/10.1007/s10877-018-0204-6

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  • DOI: https://doi.org/10.1007/s10877-018-0204-6

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