Phenoxybenzamine improves systemic oxygen delivery after the Norwood procedure. Ann Thorac Surg 1999 Jan;67(1):161-7; discussion 167-8
Date
03/23/1999Pubmed ID
10086542DOI
10.1016/s0003-4975(98)01266-1Scopus ID
2-s2.0-0032992421 (requires institutional sign-in at Scopus site) 192 CitationsAbstract
BACKGROUND: Achieving adequate systemic oxygen delivery after the Norwood procedure frequently is complicated by excessive pulmonary blood flow at the expense of systemic blood. We hypothesized that phenoxybenzamine could achieve a balanced circulation through reduction of systemic vascular resistance.
METHODS: In this prospective, nonrandomized study, oximetric catheters were placed in the superior vena cava for continuous monitoring of systemic venous oxygen saturation. Postoperative hemodynamic variables were compared between 7 control patients and 8 patients who received phenoxybenzamine.
RESULTS: The hospital survival rate was 93% (14 of 15 patients). Improvements in postoperative hemodynamics in the phenoxybenzamine group included a higher systemic venous oxygen saturation, a narrower arteriovenous oxygen content difference, a lower ratio of pulmonary to systemic flow, and a lower indexed systemic vascular resistance. In the phenoxybenzamine group, mean arterial blood pressure was related directly to systemic oxygen delivery, in contrast to the control group, where mean arterial pressure was related directly to indexed systemic vascular resistance and the ratio of pulmonary to systemic circulation.
CONCLUSIONS: Continuous postoperative monitoring of systemic venous oxygen saturation in a patient who has undergone the Norwood procedure provides early identification of low systemic oxygen delivery and an elevated ratio of pulmonary to systemic circulation. In this pilot study, phenoxybenzamine appeared to improve systemic oxygen delivery during the early postoperative period after the Norwood procedure. Further studies are indicated to confirm these results.
Author List
Tweddell JS, Hoffman GM, Fedderly RT, Berger S, Thomas JP Jr, Ghanayem NS, Kessel MW, Litwin SBAuthors
Raymond T. Fedderly MD Associate Professor in the Pediatrics department at Medical College of WisconsinGeorge M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Adrenergic alpha-AntagonistsBlood Circulation
Cardiac Surgical Procedures
Heart Defects, Congenital
Hemodynamics
Humans
Infant, Newborn
Oximetry
Oxygen
Phenoxybenzamine
Postoperative Period
Prospective Studies
Pulmonary Circulation
Vascular Resistance
Vena Cava, Superior
