Phenylephrine, a pure α-adrenergic agonist, and ephedrine, an indirectly acting α- and β-adrenergic agonist, are commonly administered during neurosurgical procedures to treat anesthesia-related hypotension and maintain cerebral perfusion pressure. In this issue of Anesthesiology, Koch et al. compared ephedrine and phenylephrine treatment on cerebral macro- and microcirculation, measured by cerebral blood flow, and capillary transit time heterogeneity, in anesthetized brain tumor patients. In an accompanying editorial, García and Brown discuss the current limitations of intraoperative brain monitoring and the implications of these new findings. Cover Illustration: A. Johnson, Vivo Visuals Studio.

  • Koch et al.: Cerebral Macro- and Microcirculation during Ephedrine versus Phenylephrine Treatment in Anesthetized Brain Tumor Patients: A Randomized Clinical Trial Using Magnetic Resonance Imaging, p. 788

  • García and Brown: Phenylephrine or Ephedrine for Intraoperative Hypotension? Consider the Cerebral Microcirculation, p. 775