Neurosciences and Neuroanaesthesia
External carotid artery flow maintains near infrared spectroscopy-determined frontal lobe oxygenation during ephedrine administration

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Background

Phenylephrine and ephedrine affect frontal lobe oxygenation ( ScO2) differently when assessed by spatially resolved near infrared spectroscopy. We evaluated the effect of phenylephrine and ephedrine on extra- vs intra-cerebral blood flow and on ScO2.

Methods

In 10 healthy males (age 20–54 yr), phenylephrine or ephedrine was infused for an ∼20 mm Hg increase in mean arterial pressure. Cerebral oxygenation (SavO2) was calculated from the arterial and jugular bulb oxygen saturations. Blood flow in the internal carotid artery (ICAf) and blood flow in the external carotid artery (ECAf) were assessed by duplex ultrasonography. Invos-5100c (SinvosO2) and Foresight (SforeO2) determined ScO2 while forehead skin oxygenation (SskinO2) was assessed.

Results

Phenylephrine reduced SforeO2 by 6.9% (95% confidence interval: 4.8–9.0%; P<0.0001), SinvosO2 by 10.5 (8.2–12.9%; P<0.0001), and ECAf (6–28%; P=0.0001), but increased ICAf (5–21%; P=0.003) albeit with no consequence for SskinO2 or SavO2. In contrast, SforeO2 was maintained with administration of ephedrine while SinvosO2 and SavO2 decreased [by 3.1 (0.7–4.5%; P=0.017) and 2.1 (0.5–3.3%; P=0.012)] as arterial carbon dioxide pressure decreased (P=0.003). ICAf was stable and ECAf increased by 11 (4–18%; P=0.005) with administration of ephedrine while SskinO2 did not change.

Conclusions

The effect of phenylephrine on ScO2 is governed by a decrease in external carotid blood flow since it increases cerebral blood flow as determined by flow in the internal carotid artery. In contrast, ScO2 is largely maintained with administration of ephedrine because blood flow to extracerebral tissue increases.

cerebral blood flow
cerebral oxygenation
ephedrine
phenylephrine
skin blood flow

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