Author: Trocheris-Fumery O et al.
Anesthesiology. doi:10.1097/ALN.0000000000005704
This single-center randomized trial at Amiens Hospital University, France, compared prophylactic norepinephrine infusion with titrated ephedrine boluses for preventing post-induction hypotension in adults over 50 years (ASA ≥2) undergoing major abdominal surgery.
A total of 500 patients were randomized, with 473 included in the intention-to-treat analysis. Continuous norepinephrine infusion (0.48 mg/h) from induction significantly reduced cumulative intraoperative hypotension episodes compared with ephedrine boluses (15% vs 74%, P < 0.001). The primary endpoint—any medico-surgical complication within 30 days—occurred less frequently in the norepinephrine group (44% vs 58%; RR 0.58 [0.40–0.83], P = 0.004).
While most secondary outcomes showed no significant difference, pulmonary complications were notably lower with norepinephrine (17% vs 31%; RR 0.46 [0.29–0.70], P < 0.001).
The authors conclude that prophylactic norepinephrine infusion at induction is more effective than ephedrine boluses in reducing post-induction hypotension and may lower postoperative complication rates in major abdominal surgery.
References
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Trocheris-Fumery O, Flet T, Scetbon C, et al. Anesthesiology. 2025. doi:10.1097/ALN.0000000000005704.
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