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...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Nature Portfolio
2023-11-01
|
Series: | Scientific Reports |
Online Access: | https://doi.org/10.1038/s41598-023-48178-2 |
_version_ | 1797415472430317568 |
---|---|
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). |
first_indexed | 2024-03-09T05:49:06Z |
format | Article |
id | doaj.art-633759139ee04b69a580c197953f3ea3 |
institution | Directory Open Access Journal |
issn | 2045-2322 |
language | English |
last_indexed | 2024-03-09T05:49:06Z |
publishDate | 2023-11-01 |
publisher | Nature Portfolio |
record_format | Article |
series | Scientific Reports |
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 |
work_keys_str_mv | AT hyungtaekim norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial AT sooholee norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial AT wonukkoh norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial AT jooyeoncho norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial AT sungwookpark norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial AT keonsikkim norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial AT youngjinro norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial AT hajungkim norepinephrinepreventshypotensioninolderpatientsunderspinalanesthesiawithintravenouspropofolsedationarandomizedcontrolledtrial |