Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

Objectives: Norepinephrine is used to increase mean arterial pressure during cardiopulmonary bypass. However, it has been suggested that norepinephrine could constrict cerebral arteries, reducing cerebral blood flow. The aim of this study, therefore, was to explore whether there was an association between doses of norepinephrine to maintain mean arterial pressure at approximate to 80 mmHg during cardiopulmonary bypass and cerebral oxygen saturation measured using near-infrared spectroscopy. Design: Observational study. Setting: University hospital. Participants: Patients undergoing cardiac surgery (n = 45) using cardiopulmonary bypass. Interventions: Norepinephrine was administered to maintain mean arterial pressure approximate to 80 mmHg during cardiopulmonary bypass. Measurements and Main Results: From initiation of cardiopulmonary bypass to removal of the aortic cross-clamp, norepinephrine dose, mean arterial pressure, partial pressure of arterial carbon dioxide, partial pressure of arterial oxygen, hemoglobin, and pump flow values were averaged over 1 minute, giving a total of 3,460 data points entered as covariates in a linear mixed model for repeated measurements, with cerebral oxygen saturation measured using near-infrared spectroscopy as outcome. There was no statistically significant association between norepinephrine dose to maintain mean arterial pressure and cerebral oxygen saturation (p = 0.46) in this model. Conclusions: Administration of norepinephrine to maintain mean arterial pressure approximate to 80 mmHg during cardiopulmonary bypass was not associated with statistically significant changes in cerebral oxygen saturation. These results indicated that norepinephrine could be used to increase mean arterial pressure during cardiopulmonary bypass without reducing cerebral oxygen saturation. (C) 2016 Elsevier Inc. All rights reserved.