Comparison of effect of different vasoactive drugs in neurointerventional surgery for patients with ischemic stroke complicated with atrial fibrillation

ZHANG Shufeng; ZHANG Xumei; LIU Jingjing; MA Yuheng; YAN Xu; LI chunxi; LIU Jin

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Medical Journal of the Chinese People Armed Police Forces ›› 2023, Vol. 34 ›› Issue (8) : 660-663.

Comparison of effect of different vasoactive drugs in neurointerventional surgery for patients with ischemic stroke complicated with atrial fibrillation

ZHANG Shufeng¹, ZHANG Xumei¹, LIU Jingjing¹, MA Yuheng², YAN Xu², LI chunxi¹, LIU Jin¹

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Abstract

Objective To compare the clinical effect of dopamine, phenylephrine and methoxamine on patients with ischemic stroke complicated with atrial fibrillation (AF) undergoing neurointerventional surgery.Methods Ninety patients with ischemic stroke complicated with atrial fibrillation undergoing neurointerventional surgery from charactenstic medical Center of Rocket Army were selected, aged 55～78 years, with an average age (67.04±5.41) years and body mass index (BMI) 19～30kg/m², American Society of Anesthesiologists (ASA) grade Ⅱ-Ⅲ and the patients were randomly divided into three groups (n=30): dopamine group (group D), phenylephrine group (group P) and methoxamine group (group M). Dopamine(5-15 μg/kg/min), phenylephrine(0.4-0.8 μg/kg/min) and methoxamine (0.4-4 μg/kg/min) were pumped intravenously from the beginning of the procedure (T₁) to 10 minutes before successful thrombectomy or stent implantation (T₄). The blood pressure range was maintained within 10% of the baseline value. After successful thrombectomy or stent implantation, the blood pressure should not exceed the lower limit of the basic value to prevent ischemia-reperfusion injury after cerebral vascular opening. FloTrac/Vigileo system was used to monitor mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), systemic vascular resistance (SVR) and stroke volume variation (SVV). The number of intraoperative arrhythmias (excluding AF) and rapid AF were recorded and the incidence of both was calculated. The average urine volume of the three groups was recorded.Results There was no significant difference in MAP or SVR among the three groups at T₁-T₄ (P>0.05). HR and CO in group P and group M were lower than those in group D at T₂, T₃, T₄ and T₅ (P<0.05). The incidence of arrhythmia in group P (13.3%) and group M(10%) was lower than that in group D (60%) (P<0.05). The incidence of rapid AF in group P (0%) and group M (0%) was lower than that in group D (23.3%) (P<0.05). There was no significant difference in the average urine volume among the three groups (P>0.05).Conclusions Dopamine, phenylephrine and methoxamine can maintain good blood pressure in patients with ischemic stroke complicated with atrial fibrillation during neurointerventional therapy, but the incidence of arrhythmia of phenylephrine and methoxamine is significantly lower than Dopamine, so they are safer and more effective.

Key words

methoxamine / phenylephrine / ischemic stroke / atrial fibrillation / neurointerventional surgery

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ZHANG Shufeng, ZHANG Xumei, LIU Jingjing, MA Yuheng, YAN Xu, LI chunxi, LIU Jin. Comparison of effect of different vasoactive drugs in neurointerventional surgery for patients with ischemic stroke complicated with atrial fibrillation[J]. Medical Journal of the Chinese People Armed Police Forces. 2023, 34(8): 660-663

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