Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial

Abstract Reducing hypotension is crucial as hypotension is the most common side effect of spinal anesthesia, and in older patients with various comorbidities, it can lead to fatality. We hypothesized that continuous infusion of norepinephrine could effectively prevent hypotension in older patients u...

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Main Authors: Hyungtae Kim, Sooho Lee, Won Uk Koh, Jooyeon Cho, Sung Wook Park, Keon Sik Kim, Young-Jin Ro, Ha-Jung Kim
Format: Article
Language:English
Published: Nature Portfolio 2023-11-01
Series:Scientific Reports
Online Access:https://doi.org/10.1038/s41598-023-48178-2
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author Hyungtae Kim
Sooho Lee
Won Uk Koh
Jooyeon Cho
Sung Wook Park
Keon Sik Kim
Young-Jin Ro
Ha-Jung Kim
author_facet Hyungtae Kim
Sooho Lee
Won Uk Koh
Jooyeon Cho
Sung Wook Park
Keon Sik Kim
Young-Jin Ro
Ha-Jung Kim
author_sort Hyungtae Kim
collection DOAJ
description Abstract Reducing hypotension is crucial as hypotension is the most common side effect of spinal anesthesia, and in older patients with various comorbidities, it can lead to fatality. We hypothesized that continuous infusion of norepinephrine could effectively prevent hypotension in older patients undergoing hip surgery under spinal anesthesia with propofol sedation. The study randomly assigned patients aged ≥ 70 years to either a control (Group C, n = 35) or a norepinephrine group (Group N, n = 35). After spinal anesthesia, continuous infusion of propofol and normal saline or norepinephrine was initiated. The number of hypotensive episodes, the primary outcome, as well as other intraoperative hemodynamic events and postoperative complications were compared. In total, 67 patients were included in the final analysis. The number of hypotensive episodes was significantly higher in Group C than in Group N (p < 0.001). Furthermore, Group C required a greater amount of fluid to maintain normovolemia (p = 0.008) and showed less urine output (p = 0.019). However, there was no difference in postoperative complications between the two groups. Continuous intravenous infusion of prophylactic norepinephrine prevented hypotensive episodes, reduced the requirement of fluid, and increased the urine output in older patients undergoing unilateral hip surgery under spinal anesthesia with propofol sedation. Clinical trial registration number: KCT0005046 ( https://cris.nih.go.kr ). IRB number: 2020-0533 (Institutional Review Board of Asan Medical Center, approval date: 13/APR/2020).
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spelling doaj.art-633759139ee04b69a580c197953f3ea32023-12-03T12:18:42ZengNature PortfolioScientific Reports2045-23222023-11-011311910.1038/s41598-023-48178-2Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trialHyungtae Kim0Sooho Lee1Won Uk Koh2Jooyeon Cho3Sung Wook Park4Keon Sik Kim5Young-Jin Ro6Ha-Jung Kim7Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary’s HospitalDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of MedicineDepartment of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Kyung Hee University College of MedicineDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of MedicineDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of MedicineAbstract Reducing hypotension is crucial as hypotension is the most common side effect of spinal anesthesia, and in older patients with various comorbidities, it can lead to fatality. We hypothesized that continuous infusion of norepinephrine could effectively prevent hypotension in older patients undergoing hip surgery under spinal anesthesia with propofol sedation. The study randomly assigned patients aged ≥ 70 years to either a control (Group C, n = 35) or a norepinephrine group (Group N, n = 35). After spinal anesthesia, continuous infusion of propofol and normal saline or norepinephrine was initiated. The number of hypotensive episodes, the primary outcome, as well as other intraoperative hemodynamic events and postoperative complications were compared. In total, 67 patients were included in the final analysis. The number of hypotensive episodes was significantly higher in Group C than in Group N (p < 0.001). Furthermore, Group C required a greater amount of fluid to maintain normovolemia (p = 0.008) and showed less urine output (p = 0.019). However, there was no difference in postoperative complications between the two groups. Continuous intravenous infusion of prophylactic norepinephrine prevented hypotensive episodes, reduced the requirement of fluid, and increased the urine output in older patients undergoing unilateral hip surgery under spinal anesthesia with propofol sedation. Clinical trial registration number: KCT0005046 ( https://cris.nih.go.kr ). IRB number: 2020-0533 (Institutional Review Board of Asan Medical Center, approval date: 13/APR/2020).https://doi.org/10.1038/s41598-023-48178-2
spellingShingle Hyungtae Kim
Sooho Lee
Won Uk Koh
Jooyeon Cho
Sung Wook Park
Keon Sik Kim
Young-Jin Ro
Ha-Jung Kim
Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial
Scientific Reports
title Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial
title_full Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial
title_fullStr Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial
title_full_unstemmed Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial
title_short Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial
title_sort norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation a randomized controlled trial
url https://doi.org/10.1038/s41598-023-48178-2
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