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British Journal of Anaesthesia 2008 100(2):240-244; doi:10.1093/bja/aem374
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effects of norepinephrine and glyceryl trinitrate on cerebral haemodynamics: transcranial Doppler study in healthy volunteers

I. K. Moppett1,*, R. W. Sherman2, M. J. Wild2, J. A. Latter2 and R. P. Mahajan1,2

1 University Department of Anaesthesia and Intensive Care, Queen's Medical Centre, Nottingham, UK
2 Nottingham University Hospitals NHS Trust, Nottingham, UK

* Corresponding author. E-mail: iain.moppett{at}nottingham.ac.uk

Background: The effects of vasoactive substances on cerebral haemodynamics are not fully known. We studied the effects of norepinephrine and glyceryl trinitrate (GTN) on cerebral haemodynamics in healthy volunteers.

Methods: The effects of norepinephrine (n=10) and GTN (n=10) on the middle cerebral artery flow velocity (MCAFV), cerebral autoregulation, reactivity to carbon dioxide, and estimated cerebral perfusion pressure (eCPP) were studied using transcranial Doppler ultrasound. Established methods were used for calculating zero flow pressure (ZFP). Measurements were made at baseline, and after i.v. infusion of the study drug to the endpoints of 25% increase in mean arterial pressure (MAP) for norepinephrine (0.02–0.1 µg kg–1 min–1), or 15% decrease in MAP for GTN (0.5–2.5 µg kg–1 min–1).

Results: The MCAFV remained unchanged with norepinephrine, but decreased slightly with GTN {from [median (inter-quartile range)] 53 (38, 62) to 48 (33, 52) cm s–1}. Cerebrovascular reactivity did not change significantly with either drug. The eCPP did not change significantly with norepinephrine, but increased significantly with GTN [from 49 (32, 54) to 62 (47, 79) mm Hg]. ZFP increased with norepinephrine [from 39 (28, 48) to 56 (46, 62) mm Hg] and decreased with GTN [from 35 (30, 49) to 12 (–7, 20) mm Hg].

Conclusions: Norepinephrine, despite increasing arterial pressure, did not increase the eCPP. The eCPP increased significantly with GTN, despite decreased MAP. Cerebral vascular tone is an important determinant of CPP during pharmacologically induced changes in arterial pressure.

Keywords: brain, blood flow; pharmacology, agonists adrenergic; pharmacology, nitroglycerin


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E-letters:

Read all E-letters

Vasoactive drugs and cerebral circulation.
Hari Krovvidi
British Journal of Anaesthesia, 12 Feb 2008 [Full text]
Vasoactive drugs and cerebral circulation: authors' reply
Iain K Moppett
British Journal of Anaesthesia, 29 Feb 2008 [Full text]
Effects of glyceryl trinitrate on cerebrovascular autoregulation
Luzius A. Steiner, et al.
British Journal of Anaesthesia, 9 May 2008 [Full text]
Re: Effects of glyceryl trinitrate on cerebrovascular autoregulation
Iain K Moppett, et al.
British Journal of Anaesthesia, 20 Jul 2008 [Full text]


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