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Ann Thorac Surg 1999;67:161-167
© 1999 The Society of Thoracic Surgeons

Original Articles

Phenoxybenzamine improves systemic oxygen delivery after the Norwood procedure1

James S. Tweddell, MDa,e, George M. Hoffman, MDb,c,e, Raymond T. Fedderly, MDd,e, Stuart Berger, MDd,e, John P. Thomas, Jr, MDd,e, Nancy S. Ghanayem, MDc,e, Maryanne W. Kessel, RNa,e, S. Bert Litwin, MDa,e

a Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
b Department of Anesthesia, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
c Department of Pediatrics, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
d Department of Critical Care, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
e Department of Pediatric Cardiology, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA

Address reprint requests to Dr Tweddell, Children’s Hospital of Wisconsin, 9000 W Wisconsin Ave, PO Box 1997, Milwaukee, WI 53201
e-mail: jstwedde{at}mcw.edu

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

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.


Related Article

Phenoxybenzamine improves systemic oxygen delivery after the Norwood procedure
James S. Tweddell, George M. Hoffman, Raymond T. Fedderly, Stuart Berger, John P. Thomas, Jr, Nancy S. Ghanayem, Maryanne W. Kessel, and S. Bert Litwin
Ann. Thorac. Surg. 1999 67: 161-167. [Abstract] [Full Text] [PDF]



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