Push-Dose Adrenaline versus Ephedrine for the Management of Intraoperative Hypotension: A Retrospective Observational Study

Abstract Background: Intraoperative hypotension (IOH) is common during anesthesia and is associated with adverse postoperative outcomes. Ephedrine is widely used to treat acute IOH, while push-dose adrenaline has emerged as a potential alternative, offering rapid hemodynamic effects. This study aimed to compare the short-term efficacy and immediate cardiovascular safety of push-dose adrenaline versus ephedrine for the management of IOH in adult surgical patients. Materials and Methods: This retrospective observational study was conducted in the operating theaters of a tertiary hospital and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Adult patients undergoing elective surgery under general or regional anesthesia who developed IOH—defined as a ≥20% reduction in systolic blood pressure (SBP) from baseline—and received either push-dose adrenaline (10 μg) or ephedrine (6 mg) were included. Patients receiving both agents were excluded. The primary outcome was the change in SBP within 5 min of vasopressor administration. Safety outcomes included hypertension, tachycardia, and new intraoperative electrocardiographic (ECG) abnormalities. Results: Of 158 screened cases, 151 patients were analyzed (78 adrenaline and 73 ephedrine). Baseline demographic and hemodynamic characteristics were comparable between groups. The mean increase in SBP was significantly greater with adrenaline than with ephedrine (18.6 ± 9.7 vs 12.1 ± 6.7 mm Hg; P < 0.001). The incidence of hypertension, tachycardia, and ECG abnormalities was low and did not differ significantly between groups. Conclusion: Push-dose adrenaline produced a more pronounced short-term increase in SBP than ephedrine without evidence of immediate cardiovascular harm. Prospective studies are needed to confirm safety and evaluate clinically meaningful outcomes.