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Cafedrine/theodrenaline in anaesthesia: influencing factors in restoring arterial blood pressure.

Heller AR, Heger J, Gama de Abreu M, Müller MP - Anaesthesist (2015)

Bottom Line: Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure [1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline)] compared with healthy patients [1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline)] (p = 0.005).Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect.Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany, axel.heller@uniklinkum-dresden.de.

ABSTRACT

Background: Hypotensive states that require fast stabilisation of blood pressure can occur during anaesthesia. In 1963, the 20:1 mixture of cafedrine/theodrenaline (Akrinor) was introduced in Germany for use in anaesthesia and emergency medicine in the first-line management of hypotensive states. Though on the market for many years, few pharmacodynamic data are available on this combination net beta-mimetic agent.

Aim: This study aimed to examine the drug combination in real-life clinical practice and recorded time to 10 % mean arterial blood pressure (MAP) increase and heart rate. Furthermore, potential factors that influence drug effectiveness under anaesthesia were assessed.

Methods: Data were collected within a standardised anaesthesia protocol. A total of 353 consecutive patients (female/male = 149/204) who received cafedrine/theodrenaline after a drop in MAP ≥ 5% were included in the study. The time to 10 % increase in MAP, dosage of cafedrine/theodrenaline, volume loading, blood pressure and heart rate were monitored over time.

Results: Patients were a mean (standard deviation) of 64.4 ± 15.1 years old with a baseline MAP of 82 ± 14 mmHg, which dropped to a mean of 63 ± 10 mmHg during anaesthesia without gender differences. Cafedrine/theodrenaline (1.27 ± 1.0 mg/kg; 64 ± 50 µg/kg) significantly increased MAP (p < 0.001) by 11 ± 16 mmHg within 5 min, reaching peak values within 17.4 ± 9.0 min. Heart rate was not affected in a clinically significant manner. Cafedrine/theodrenaline induced a 10% MAP increase after 7.2 ± 4.6 min (women) and after 8.6 ± 6.3 min (men) (p = 0.018). Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure [1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline)] compared with healthy patients [1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline)] (p = 0.005). Concomitant medication with beta-blocking agents significantly prolonged the time to 10 % MAP increase [9.0 ± 7.0 vs. 7.3 ± 4.3 min (p = 0.008)].

Conclusion: Cafedrine/theodrenaline quickly restores MAP during anaesthesia. Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect. Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.

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Related in: MedlinePlus

Kaplan–Meier analysis of the time to 10 % mean arterial pressure (MAP) increase in male (dotted line) and female (solid line) patients after cafedrine/theodrenaline injection at time point 0 (p = 0.018, log-rank test)
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Fig3: Kaplan–Meier analysis of the time to 10 % mean arterial pressure (MAP) increase in male (dotted line) and female (solid line) patients after cafedrine/theodrenaline injection at time point 0 (p = 0.018, log-rank test)

Mentions: Heart rates did not differ significantly between genders (Fig. 2). After the drop in blood pressure cafedrine/theodrenaline induced a 10 % increase in MAP significantly earlier in women 7.2 ± 4.6 vs. 8.6 ± 6.3 min in men (p = 0.018) (Table 2, Fig. 3), however, the duration of the pressure-elevating effect as assessed by the time to peak MAP did not differ in a gender-related manner (Table 2).Fig. 3


Cafedrine/theodrenaline in anaesthesia: influencing factors in restoring arterial blood pressure.

Heller AR, Heger J, Gama de Abreu M, Müller MP - Anaesthesist (2015)

Kaplan–Meier analysis of the time to 10 % mean arterial pressure (MAP) increase in male (dotted line) and female (solid line) patients after cafedrine/theodrenaline injection at time point 0 (p = 0.018, log-rank test)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4383809&req=5

Fig3: Kaplan–Meier analysis of the time to 10 % mean arterial pressure (MAP) increase in male (dotted line) and female (solid line) patients after cafedrine/theodrenaline injection at time point 0 (p = 0.018, log-rank test)
Mentions: Heart rates did not differ significantly between genders (Fig. 2). After the drop in blood pressure cafedrine/theodrenaline induced a 10 % increase in MAP significantly earlier in women 7.2 ± 4.6 vs. 8.6 ± 6.3 min in men (p = 0.018) (Table 2, Fig. 3), however, the duration of the pressure-elevating effect as assessed by the time to peak MAP did not differ in a gender-related manner (Table 2).Fig. 3

Bottom Line: Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure [1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline)] compared with healthy patients [1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline)] (p = 0.005).Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect.Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany, axel.heller@uniklinkum-dresden.de.

ABSTRACT

Background: Hypotensive states that require fast stabilisation of blood pressure can occur during anaesthesia. In 1963, the 20:1 mixture of cafedrine/theodrenaline (Akrinor) was introduced in Germany for use in anaesthesia and emergency medicine in the first-line management of hypotensive states. Though on the market for many years, few pharmacodynamic data are available on this combination net beta-mimetic agent.

Aim: This study aimed to examine the drug combination in real-life clinical practice and recorded time to 10 % mean arterial blood pressure (MAP) increase and heart rate. Furthermore, potential factors that influence drug effectiveness under anaesthesia were assessed.

Methods: Data were collected within a standardised anaesthesia protocol. A total of 353 consecutive patients (female/male = 149/204) who received cafedrine/theodrenaline after a drop in MAP ≥ 5% were included in the study. The time to 10 % increase in MAP, dosage of cafedrine/theodrenaline, volume loading, blood pressure and heart rate were monitored over time.

Results: Patients were a mean (standard deviation) of 64.4 ± 15.1 years old with a baseline MAP of 82 ± 14 mmHg, which dropped to a mean of 63 ± 10 mmHg during anaesthesia without gender differences. Cafedrine/theodrenaline (1.27 ± 1.0 mg/kg; 64 ± 50 µg/kg) significantly increased MAP (p < 0.001) by 11 ± 16 mmHg within 5 min, reaching peak values within 17.4 ± 9.0 min. Heart rate was not affected in a clinically significant manner. Cafedrine/theodrenaline induced a 10% MAP increase after 7.2 ± 4.6 min (women) and after 8.6 ± 6.3 min (men) (p = 0.018). Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure [1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline)] compared with healthy patients [1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline)] (p = 0.005). Concomitant medication with beta-blocking agents significantly prolonged the time to 10 % MAP increase [9.0 ± 7.0 vs. 7.3 ± 4.3 min (p = 0.008)].

Conclusion: Cafedrine/theodrenaline quickly restores MAP during anaesthesia. Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect. Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.

Show MeSH
Related in: MedlinePlus