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Effects of catecholamines on cerebral blood vessels in patients with traumatic brain injury

Published online by Cambridge University Press:  01 February 2008

D. Pfister ,
S. P. Strebel  and
L. A. Steiner
D. Pfister
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
S. P. Strebel
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
L. A. Steiner*
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
*
Correspondence to: Luzius A. Steiner, Department of Anaesthesia, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland. E-mail: [email protected]; Tel: +41 61 265 25 25; Fax: +41 61 265 73 20
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Summary

Data on the cerebrovascular effects of catecholamines after head injury are difficult both to interpret and to compare. Diverse parameters with regard to brain trauma animal models, methods of determining the effects on the cerebral blood flow and metabolism and choice of end-points have been used. Many studies investigate the cerebrovascular effects of catecholamines over a range of cerebral perfusion pressures above the range recommended by current guidelines. The relationship between patient outcome and the use of a specific substance to improve cerebral perfusion has not been investigated. Dopamine, norepinephrine and phenylephrine all seem to increase cerebral blood flow in various animal models and in patients. The data suggest that norepinephrine may be the most predictable. It is associated with an improved restoration of global and regional oxygenation when compared to dopamine. Dopamine has been associated with an increase in brain oedema. There is further evidence that dopamine has many disadvantages in critically ill patients due to its ability to suppress circulating concentrations of most anterior pituitary-dependent hormones. Both aspects would further discourage its use. Data on phenylephrine are scarce. It has been associated with increased intracranial pressure and a failure to improve cerebral oxygenation despite markedly improved cerebral perfusion pressure. For all other catecholamines and related substances there are insufficient data on the cerebrovascular effects after head injury. This suggests that norepinephrine may be the catecholamine that is the most suitable substance to maintain or restore adequate cerebral perfusion. The data, however, are insufficient to formulate a guideline.

Keywords

BRAIN INJURYTRAUMAREGIONAL BLOOD FLOW, brainCATECHOLAMINES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue S42 , February 2008 , pp. 98 - 103
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Edvinsson, L, Krause, DN. Catecholamines. In: Edvinsson, L, Krause, DN, eds. Cerebral Blood Flow and Metabolism. Philadelphia: Lippincott, Williams & Wilkins, 2002: 191–211.Google Scholar
2.Chillon, J-M, Baumbach, GL. Autoregulation: arterial and intracranial pressure. In: Edvinsson, L, Krause, DN, eds. Cerebral Blood Flow and Metabolism. Philadelphia: Lippincott Williams & Wilkins, 2002: 395–412.Google Scholar
3.Mascia, L, Andrews, PJ, McKeating, EG, Souter, MJ, Merrick, MV, Piper, IR. Cerebral blood flow and metabolism in severe brain injury: the role of pressure autoregulation during cerebral perfusion pressure management. Intensive Care Med 2000; 26: 202–205.CrossRefGoogle ScholarPubMed
4.Moppett, IK, Wild, MJ, Sherman, RW, Latter, JA, Miller, K, Mahajan, RP. Effects of ephedrine, dobutamine and dopexamine on cerebral haemodynamics: transcranial Doppler studies in healthy volunteers. Br J Anaesth 2004; 92: 39–44.CrossRefGoogle ScholarPubMed
5.Hurn, PD, Traystman, RJ. Changes in arterial gas tension. In: Edvinsson, L, Krause, DN, eds. Cerebral Blood Flow and Metabolism. Philadelphia: Lippincott Williams & Wilkins, 2002: 384–394.Google Scholar
6.Sokrab, TE, Johansson, BB. Regional cerebral blood flow in acute hypertension induced by adrenaline, noradrenaline and phenylephrine in the conscious rat. Acta Physiol Scand 1989; 137: 101–106.CrossRefGoogle ScholarPubMed
7.Myburgh, JA, Upton, RN, Grant, C, Martinez, A. A comparison of the effects of norepinephrine, epinephrine, and dopamine on cerebral blood flow and oxygen utilisation. Acta Neurochir Suppl (Wien) 1998; 71: 19–21.Google ScholarPubMed
8.Myburgh, JA, Upton, RN, Grant, C, Martinez, A. The effect of infusions of adrenaline, noradrenaline and dopamine on cerebral autoregulation under isoflurane anaesthesia in an ovine model. Anaesth Intensive Care 2003; 31: 259–266.CrossRefGoogle Scholar
9.Myburgh, JA, Upton, RN, Grant, C, Martinez, A. The effect of infusions of adrenaline, noradrenaline and dopamine on cerebral autoregulation under propofol anaesthesia in an ovine model. Intensive Care Med 2003; 29: 817–824.CrossRefGoogle Scholar
10.Strebel, SP, Kindler, C, Bissonnette, B, Tschaler, G, Deanovic, D. The impact of systemic vasoconstrictors on the cerebral circulation of anesthetized patients. Anesthesiology 1998; 89: 67–72.CrossRefGoogle ScholarPubMed
11.Steiner, LA, Johnston, AJ, Chatfield, DA et al. . The effects of large-dose propofol on cerebrovascular pressure autoregulation in head-injured patients. Anesth Analg 2003; 97: 572–576.CrossRefGoogle ScholarPubMed
12.Myburgh, JA, Upton, RN, Grant, C, Martinez, A. Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive Care Med 2001; 27: 276–282.CrossRefGoogle Scholar
13.Kroppenstedt, SN, Stover, JF, Unterberg, AW. Effects of dopamine on posttraumatic cerebral blood flow, brain edema, and cerebrospinal fluid glutamate and hypoxanthine concentrations. Crit Care Med 2000; 28: 3792–3798.CrossRefGoogle ScholarPubMed
14.Kroppenstedt, SN, Sakowitz, OW, Thomale, UW, Unterberg, AW, Stover, JF. Norepinephrine is superior to dopamine in increasing cortical perfusion following controlled cortical impact injury in rats. Acta Neurochir Suppl 2002; 81: 225–227.Google ScholarPubMed
15.Kroppenstedt, SN, Sakowitz, OW, Thomale, UW, Unterberg, AW, Stover, JF. Influence of norepinephrine and dopamine on cortical perfusion, EEG activity, extracellular glutamate, and brain edema in rats after controlled cortical impact injury. J Neurotrauma 2002; 19: 1421–1432.CrossRefGoogle ScholarPubMed
16.Kroppenstedt, SN, Thomale, UW, Griebenow, M et al. . Effects of early and late intravenous norepinephrine infusion on cerebral perfusion, microcirculation, brain-tissue oxygenation, and edema formation in brain-injured rats. Crit Care Med 2003; 31: 2211–2221.CrossRefGoogle ScholarPubMed
17.Ract, C, Vigue, B, Bodjarian, N, Mazoit, JX, Samii, K, Tadie, M. Comparison of dopamine and norepinephrine after traumatic brain injury and hypoxic-hypotensive insult. J Neurotrauma 2001; 18: 1247–1254.CrossRefGoogle ScholarPubMed
18.Stubbe, HD, Greiner, C, Westphal, M et al. . Cerebral response to norepinephrine compared with fluid resuscitation in ovine traumatic brain injury and systemic inflammation. Crit Care Med 2006; 34: 2651–2657.CrossRefGoogle ScholarPubMed
19.Cherian, L, Chacko, G, Goodman, JC, Robertson, CS. Cerebral hemodynamic effects of phenylephrine and L-arginine after cortical impact injury. Crit Care Med 1999; 27: 2512–2517.CrossRefGoogle ScholarPubMed
20.Steiner, LA, Johnston, AJ, Czosnyka, M et al. . Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients. Crit Care Med 2004; 32: 1049–1054.CrossRefGoogle ScholarPubMed
21.Ract, C, Vigue, B. Comparison of the cerebral effects of dopamine and norepinephrine in severely head-injured patients. Intensive Care Med 2001; 27: 101–106.CrossRefGoogle ScholarPubMed
22.Chieregato, A, Fainardi, E, Tanfani, A et al. . Induced acute arterial hypertension and regional cerebral flow in intracontusional low density area. Acta Neurochir Suppl 2003; 86: 361–365.Google ScholarPubMed
23.Steiner, LA, Coles, JP, Johnston, AJ et al. . Responses of posttraumatic pericontusional cerebral blood flow and blood volume to an increase in cerebral perfusion pressure. J Cereb Blood Flow Metab 2003; 23: 1371–1377.CrossRefGoogle Scholar
24.http://www2.braintrauma.org/guidelines/. Guidelines for the management of severe traumatic brain injury: Cerebral perfusion pressure (Updated 5.1.2003). 2003.Google Scholar
25.Malhotra, AK, Schweitzer, JB, Fox, JL, Fabian, TC, Proctor, KG. Cerebral perfusion pressure directed therapy following traumatic brain injury and hypotension in swine. J Neurotrauma 2003; 20: 827–839.CrossRefGoogle ScholarPubMed
26.Johnston, AJ, Steiner, LA, Chatfield, DA et al. . Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury. Intensive Care Med 2004; 30: 791–797.CrossRefGoogle ScholarPubMed
27.Sahuquillo, J, Amoros, S, Santos, A et al. . Does an increase in cerebral perfusion pressure always mean a better oxygenated brain? A study in head-injured patients. Acta Neurochir Suppl 2000; 76: 457–462.Google Scholar
28.Johnston, AJ, Steiner, LA, Coles, JP et al. . Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med 2005; 33: 189–195.CrossRefGoogle ScholarPubMed
29.Coles, JP, Steiner, LA, Johnston, AJ et al. . Does induced hypertension reduce cerebral ischaemia within the traumatized human brain? Brain 2004; 127: 2479–2490.CrossRefGoogle ScholarPubMed
30.Kroppenstedt, SN, Kern, M, Thomale, UW, Schneider, GH, Lanksch, WR, Unterberg, AW. Effect of cerebral perfusion pressure on contusion volume following impact injury. J Neurosurg 1999; 90: 520–526.CrossRefGoogle ScholarPubMed
31.Stover, JF, Sakowitz, OW, Thomale, UW, Kroppenstedt, SN, Unterberg, AW. Norepinephrine-induced hyperglycemia does not increase cortical lactate in brain-injured rats. Intensive Care Med 2002; 28: 1491–1497.CrossRefGoogle Scholar
32.Beaumont, A, Hayasaki, K, Marmarou, A, Barzo, P, Fatouros, P, Corwin, F. Contrasting effects of dopamine therapy in experimental brain injury. J Neurotrauma 2001; 18: 1359–1372.CrossRefGoogle ScholarPubMed
33.Beaumont, A, Hayasaki, K, Marmarou, A, Barzo, P, Fatouros, P, Corwin, F. The effects of dopamine on edema formation in two models of traumatic brain injury. Acta Neurochir Suppl 2000; 76: 147–151.Google ScholarPubMed
34.Alspaugh, DM, Sartorelli, K, Shackford, SR, Okum, EJ, Buckingham, S, Osler, T. Prehospital resuscitation with phenylephrine in uncontrolled hemorrhagic shock and brain injury. J Trauma 2000; 48: 851–863; discussion 863–854.CrossRefGoogle ScholarPubMed
35.Van den Berghe, G, de Zegher, F. Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 1996; 24: 1580–1590.CrossRefGoogle ScholarPubMed
36.Robertson, CS, Valadka, AB, Hannay, HJ et al. . Prevention of secondary ischemic insults after severe head injury. Crit Care Med 1999; 27: 2086–2095.CrossRefGoogle ScholarPubMed
37.Contant, CF, Valadka, AB, Gopinath, SP, Hannay, HJ, Robertson, CS. Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury. J Neurosurg 2001; 95: 560–568.CrossRefGoogle ScholarPubMed
38.Corbett, SM, Moore, J, Rebuck, JA, Rogers, FB, Greene, CM. Survival of propofol infusion syndrome in a head-injured patient. Crit Care Med 2006; 34: 2479–2483.CrossRefGoogle Scholar