Influence of norepinephrine and phenylephrine on frontal lobe oxygenation during cardiopulmonary bypass in patients with diabetes

Objective Although utilization of vasopressors recently has been associated with reduced cerebral oxygenation, the influence of vasopressors on cerebral oxygenation during cardiopulmonary bypass in patients with diabetes is unknown. The aim of this study was to document the impact of norepinephrine and phenylephrine utilization on cerebral oxygenation in patients with and without diabetes during cardiopulmonary bypass. Design Prospective, clinical study. Setting Academic medical center. Participants Fourteen patients with diabetes and 17 patients without diabetes undergoing cardiac surgery. Interventions During cardiopulmonary bypass, norepinephrine (diabetics n = 6; non-diabetics n = 8) or phenylephrine (diabetics n = 8; non-diabetics n = 9) was administered intravenously to maintain mean arterial pressure above 60 mmHg. Measurements and Main Results Mean arterial pressure, venous temperature, arterial oxygenation, and frontal lobe oxygenation (monitored by near-infrared spectroscopy) were recorded before anesthesia induction (baseline) and continuously during cardiopulmonary bypass. Frontal lobe oxygenation was lowered to a greater extent in diabetics versus non-diabetics with administration of norepinephrine (-14±13 v 3±12%; p<0.05). There was also a trend towards a greater reduction in cerebral oxygenation in diabetics versus non-diabetics with administration of phenylephrine (-12±8 v -6±7%; p = 0.1) during cardiopulmonary bypass. Conclusions Administration of norepinephrine to restore mean arterial pressure during cardiopulmonary bypass is associated with a reduction in frontal lobe oxygenation in diabetics but not in patients without diabetes. Administration of phenylephrine also were associated with a trend towards a greater reduction in frontal lobe oxygenation in diabetics. The clinical implications of these findings deserve future consideration.