Alemayehu H Jufar,Clive N May,Taku Furukawa,Roger G Evans,Andrew D Cochrane,Bruno Marino,Jaishankar Raman,Peter R McCall,Abraham Hulst,Sally G Hood,Anton Trask-Marino,Rinaldo Bellomo,Lachlan F Miles,Yugeesh R Lankadeva
INTRODUCTIONIntra-operative hypotension is common during cardiopulmonary bypass and may contribute to tissue hypoxia. Tissue hypoxia has been linked to the development of postoperative kidney and brain injury. Vasopressors are used to treat hypotension during and after cardiopulmonary bypass. However, the effects of these drugs on renal and cerebral tissue oxygenation and perfusion are unknown. We tested the effects of four vasopressors on renal and cerebral tissue perfusion and oxygenation in a clinically-relevant ovine model of cardiopulmonary bypass.METHODSWe studied 16 sheep before and after induction of anaesthesia and during 2.5 h of cardiopulmonary bypass. After commencing cardiopulmonary bypass at a target non-pulsatile flow of 2.4 l.min-1.m-2, we observed a baseline period with a target mean arterial pressure of 50-60 mmHg, after which we targeted a mean arterial pressure of 75-85 mmHg using a continuous infusion of metaraminol (n = 8); noradrenaline (n = 8); phenylephrine (n = 8); or vasopressin (n = 7). Sheep were allocated randomly to receive two of the four vasopressors.RESULTSCompared with the pre-induction state, cardiopulmonary bypass significantly decreased renal medullary tissue perfusion (median (IQR [range]) decrease 55 (4-82 [1-99])%; p = 0.01) and medullary oxygen tension (mean (SD) difference 3.1 (2.5) kPa; p < 0.001). Cardiopulmonary bypass did not significantly alter cerebral tissue perfusion or oxygenation compared with the pre-induction state. Infusing noradrenaline significantly decreased medullary oxygen tension (mean (SD) difference 2.7 (1.6) kPa; p = 0.003). This decrease in medullary oxygen tension was significant compared with vasopressin (mean difference -3.4 kPa, 95%CI -5.7 to -1.0; p = 0.008). No vasopressor infusion significantly altered renal medullary perfusion, cerebral tissue perfusion or oxygenation.DISCUSSIONIntra-operative noradrenaline during ovine cardiopulmonary bypass worsens renal medullary tissue oxygenation relative to vasopressin. These findings suggest that the choice of vasopressors may affect renal oxygenation.
{"title":"Effects of noradrenaline, vasopressin, phenylephrine or metaraminol on kidney and brain microcirculation in ovine cardiopulmonary bypass: a randomised trial.","authors":"Alemayehu H Jufar,Clive N May,Taku Furukawa,Roger G Evans,Andrew D Cochrane,Bruno Marino,Jaishankar Raman,Peter R McCall,Abraham Hulst,Sally G Hood,Anton Trask-Marino,Rinaldo Bellomo,Lachlan F Miles,Yugeesh R Lankadeva","doi":"10.1111/anae.70049","DOIUrl":"https://doi.org/10.1111/anae.70049","url":null,"abstract":"INTRODUCTIONIntra-operative hypotension is common during cardiopulmonary bypass and may contribute to tissue hypoxia. Tissue hypoxia has been linked to the development of postoperative kidney and brain injury. Vasopressors are used to treat hypotension during and after cardiopulmonary bypass. However, the effects of these drugs on renal and cerebral tissue oxygenation and perfusion are unknown. We tested the effects of four vasopressors on renal and cerebral tissue perfusion and oxygenation in a clinically-relevant ovine model of cardiopulmonary bypass.METHODSWe studied 16 sheep before and after induction of anaesthesia and during 2.5 h of cardiopulmonary bypass. After commencing cardiopulmonary bypass at a target non-pulsatile flow of 2.4 l.min-1.m-2, we observed a baseline period with a target mean arterial pressure of 50-60 mmHg, after which we targeted a mean arterial pressure of 75-85 mmHg using a continuous infusion of metaraminol (n = 8); noradrenaline (n = 8); phenylephrine (n = 8); or vasopressin (n = 7). Sheep were allocated randomly to receive two of the four vasopressors.RESULTSCompared with the pre-induction state, cardiopulmonary bypass significantly decreased renal medullary tissue perfusion (median (IQR [range]) decrease 55 (4-82 [1-99])%; p = 0.01) and medullary oxygen tension (mean (SD) difference 3.1 (2.5) kPa; p < 0.001). Cardiopulmonary bypass did not significantly alter cerebral tissue perfusion or oxygenation compared with the pre-induction state. Infusing noradrenaline significantly decreased medullary oxygen tension (mean (SD) difference 2.7 (1.6) kPa; p = 0.003). This decrease in medullary oxygen tension was significant compared with vasopressin (mean difference -3.4 kPa, 95%CI -5.7 to -1.0; p = 0.008). No vasopressor infusion significantly altered renal medullary perfusion, cerebral tissue perfusion or oxygenation.DISCUSSIONIntra-operative noradrenaline during ovine cardiopulmonary bypass worsens renal medullary tissue oxygenation relative to vasopressin. These findings suggest that the choice of vasopressors may affect renal oxygenation.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"143 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effects of anaesthesia and surgery on sleep–wake timing and subjective sleep quality in children: a reply","authors":"Jorinde A. W. Polderman, Mark L. van Zuylen","doi":"10.1111/anae.70071","DOIUrl":"https://doi.org/10.1111/anae.70071","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"61 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Routine pre‐operative modified telephone interview for cognitive status screening: feasible, but is it justified?","authors":"Mark L. van Zuylen","doi":"10.1111/anae.70064","DOIUrl":"https://doi.org/10.1111/anae.70064","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"39 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renata K. Carvalho, Gustavo A. Moreira, Sergio Tufik, Monica L. Andersen
{"title":"Time, sleep and children: integrating chronobiology into anaesthesia","authors":"Renata K. Carvalho, Gustavo A. Moreira, Sergio Tufik, Monica L. Andersen","doi":"10.1111/anae.70065","DOIUrl":"https://doi.org/10.1111/anae.70065","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"13 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The ‘afternoon effect’ as a proxy for systemic vulnerabilities in surgical care","authors":"Yu‐Chi Su, Pei‐Yi Hung, Ming‐Hui Hung","doi":"10.1111/anae.70066","DOIUrl":"https://doi.org/10.1111/anae.70066","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"14 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dexmedetomidine and postoperative cardiac surgical delirium: methodological concerns and small effect sizes","authors":"Liwen Liu, Gaosheng Su, Zhong Lin","doi":"10.1111/anae.70073","DOIUrl":"https://doi.org/10.1111/anae.70073","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"100 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hyperangulated videolaryngoscopy: stylet first until benefit of bougie is shown.","authors":"Tim Cook,Benjamin Dallyn,Ronan Hanratty, ","doi":"10.1111/anae.70062","DOIUrl":"https://doi.org/10.1111/anae.70062","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"36 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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