Continuous versus bolus norepinephrine administration to treat hypotension after induction of general anaesthesia in low-to-moderate risk noncardiac surgery patients: a randomised trial.
Kristen K Thomsen, Finn Külls, Christina Vokuhl, Linda Krause, Dominik Müller, Max Bossemeyer, Mirja Wegge, Alina Kröker, Alina Bergholz, Christian Zöllner, Daniel I Sessler, Bernd Saugel
{"title":"Continuous versus bolus norepinephrine administration to treat hypotension after induction of general anaesthesia in low-to-moderate risk noncardiac surgery patients: a randomised trial.","authors":"Kristen K Thomsen, Finn Külls, Christina Vokuhl, Linda Krause, Dominik Müller, Max Bossemeyer, Mirja Wegge, Alina Kröker, Alina Bergholz, Christian Zöllner, Daniel I Sessler, Bernd Saugel","doi":"10.1016/j.bja.2025.03.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hypotension after induction of general anaesthesia (postinduction hypotension) is common in patients undergoing noncardiac surgery and frequently requires treatment with vasopressors such as norepinephrine. We tested the hypothesis that giving norepinephrine continuously using a syringe infusion pump, compared with giving it as repeated manual boluses, reduces postinduction hypotension within 15 min after starting induction of general anaesthesia in low-to-moderate risk noncardiac surgery patients.</p><p><strong>Methods: </strong>Patients undergoing elective noncardiac surgery were randomised to either continuous norepinephrine infusion or manual bolus norepinephrine administration intravenously during induction of general anaesthesia. In both groups, norepinephrine was administered through a peripheral venous catheter. Blood pressure was measured by clinicians using intermittent oscillometry. We additionally performed blinded continuous noninvasive blood pressure monitoring to quantify the duration and extent of postinduction hypotension. The primary endpoint was postinduction hypotension, defined as the area under a MAP of 65 mm Hg within 15 min after starting induction of general anaesthesia.</p><p><strong>Results: </strong>From 276 randomised patients, 261 had complete data (median age: 62 yr; 40% female). The median (25th-75th percentile) area under a MAP of 65 mm Hg was 3.6 (0.0-16.6) mm Hg × min in patients assigned to continuous norepinephrine infusion, compared with 5.5 (0.5-24.5) mm Hg × min in patients assigned to manual bolus norepinephrine administration (P=0.070). The median duration of MAP values <65 mm Hg was 1.0 (0.0-2.5) min vs 1.4 (0.2-3.2) min (P=0.052).</p><p><strong>Conclusions: </strong>Continuous administration of norepinephrine, compared with repeated manual bolus doses, did not reduce postinduction hypotension in low-to-moderate risk noncardiac surgery patients who had intermittent oscillometric blood pressure monitoring.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":9.1000,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.bja.2025.03.017","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hypotension after induction of general anaesthesia (postinduction hypotension) is common in patients undergoing noncardiac surgery and frequently requires treatment with vasopressors such as norepinephrine. We tested the hypothesis that giving norepinephrine continuously using a syringe infusion pump, compared with giving it as repeated manual boluses, reduces postinduction hypotension within 15 min after starting induction of general anaesthesia in low-to-moderate risk noncardiac surgery patients.
Methods: Patients undergoing elective noncardiac surgery were randomised to either continuous norepinephrine infusion or manual bolus norepinephrine administration intravenously during induction of general anaesthesia. In both groups, norepinephrine was administered through a peripheral venous catheter. Blood pressure was measured by clinicians using intermittent oscillometry. We additionally performed blinded continuous noninvasive blood pressure monitoring to quantify the duration and extent of postinduction hypotension. The primary endpoint was postinduction hypotension, defined as the area under a MAP of 65 mm Hg within 15 min after starting induction of general anaesthesia.
Results: From 276 randomised patients, 261 had complete data (median age: 62 yr; 40% female). The median (25th-75th percentile) area under a MAP of 65 mm Hg was 3.6 (0.0-16.6) mm Hg × min in patients assigned to continuous norepinephrine infusion, compared with 5.5 (0.5-24.5) mm Hg × min in patients assigned to manual bolus norepinephrine administration (P=0.070). The median duration of MAP values <65 mm Hg was 1.0 (0.0-2.5) min vs 1.4 (0.2-3.2) min (P=0.052).
Conclusions: Continuous administration of norepinephrine, compared with repeated manual bolus doses, did not reduce postinduction hypotension in low-to-moderate risk noncardiac surgery patients who had intermittent oscillometric blood pressure monitoring.
背景：全麻诱导后低血压（诱导后低血压）在接受非心脏手术的患者中很常见，通常需要血管加压剂如去甲肾上腺素治疗。我们检验了这样的假设：与反复手动给药相比，使用注射器泵持续给药去甲肾上腺素可以降低低至中等风险非心脏手术患者在开始全麻诱导后15分钟内的诱导后低血压。方法：接受选择性非心脏手术的患者在全麻诱导期间随机分为连续输注去甲肾上腺素组和手动大剂量静脉注射去甲肾上腺素组。两组患者均通过外周静脉导管给予去甲肾上腺素。临床医生使用间歇振荡法测量血压。我们还进行了盲法连续无创血压监测，以量化诱导后低血压的持续时间和程度。主要终点是诱导后低血压，定义为全麻开始诱导后15分钟内MAP下65 mm Hg的区域。结果：276例随机分组患者中，261例数据完整(中位年龄：62岁；40%的女性)。持续输注去甲肾上腺素的患者在65 mm Hg的MAP下的中位面积（25 -75百分位数）为3.6 (0.0-16.6)mm Hg × min，而手动注射去甲肾上腺素的患者为5.5 (0.5-24.5)mm Hg × min （P=0.070）。结论：持续给药去甲肾上腺素，与重复手动给药相比，并没有降低低至中度风险非心脏手术患者的诱导后低血压，这些患者有间歇性的振荡血压监测。
期刊介绍：
The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience.
The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence.
Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
