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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: lsteiner@uhbs.ch; 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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