What is the clinical evidence from this study?

Study design: Observational. Population: Patients requiring intravenous adrenaline during general anaesthesia (n=591). Intervention: Intravenous adrenaline. Primary outcome: Incidence of intravenous adrenaline administration per 1,000 anaesthetic procedures.

What question did this study set out to answer?

To evaluate the incidence, dosing patterns, and early adverse events associated with perioperative intravenous adrenaline administration during general anaesthesia.

March 26, 2026BMC AnesthesiologyOpen Access

Intravenous adrenaline during general anaesthesia: incidence and adverse events over 11 years

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Key result

IV adrenaline during general anesthesia is linked to acute hemodynamic events, with severe hypertension in ~31%.

n=591

Why the study?

Data on early adverse events following intravenous adrenaline injection are limited.

Population

591 adult patients who received intravenous adrenaline during general anaesthesia

Design

Retrospective single-centre cohort study

Follow-up

3 months

Authors

DRDamien RousseleauUniversité de Lille ABAlexandre Bourgeois LCLucas Chéneau

Discussion

Member takes

Implication

Warrants caution with IV adrenaline during anaesthesia; extends real-world evidence of haemodynamic risks and leaves mitigation strategies open.

Key Points

To evaluate the incidence, dosing patterns, and early adverse events associated with perioperative intravenous adrenaline administration during general anaesthesia.
Retrospective, single-centre study analyzing 549,089 adult anaesthetic procedures performed at Lille University Hospital between January 2012 and December 2023.
Excluded patients who received non-intravenous routes, continuous infusions only, or underwent cardiothoracic surgery.
Extracted clinical warehouse data on indication, cumulative adrenaline dose, and adverse outcomes including severe hypertension, tachycardia, Takotsubo syndrome, and intracerebral haemorrhage.
Intravenous adrenaline was administered in 591 cases (incidence: 1.07/1,000), with median cumulative doses of 5,000 µg (IQR [2,000–10,000]) for cardiac arrest, 300 µg [100–1,000] for refractory hypotension, and 200 µg [100–1,000] for anaphylaxis.
Acute adverse events were frequent, led by tachycardia in 47% of cases, severe hypertension in 31%, Takotsubo syndrome in 3%, and intracerebral haemorrhage in 1%.
Three-month mortality differed markedly according to indication: 70.3% in cardiac arrest, 30.0% in refractory hypotension, and 3.0% in anaphylaxis.

Study Design

Type

Observational (n=591)

Multicenter

Structured PICO

Population

Adult patients who received intravenous adrenaline during general anaesthesia for non-cardiothoracic surgery

Intervention

Intravenous adrenaline (bolus)

Outcome

Incidence of intravenous adrenaline administration and adverse event patterns (severe hypertension, tachycardia, Takotsubo syndrome, and intracerebral haemorrhage)safety

Intravenous adrenaline is rarely used during general anaesthesia but is associated with frequent acute haemodynamic adverse events, including severe hypertension in nearly a third of patients.

Limitations

Retrospective nature limits causal inference
Single-centre study in a tertiary hospital, potentially limiting generalisability
Pragmatic definition of refractory hypotension based on manual chart review rather than a strict predefined haemodynamic threshold
Outcome assessment for Takotsubo syndrome and intracerebral haemorrhage relied primarily on administrative coding
Analysis was performed on the cumulative adrenaline dose and not the repetition of administered dose
Variables such as arrhythmia and depth of anaesthesia were not reported
Did not analyse the effects of repeated bolus versus continuous administration
Focused exclusively on safety outcomes and cannot establish the overall benefit-risk balance of adrenaline
Single-centre study conducted in a tertiary hospital, potentially limiting generalisability
Pragmatic definition of refractory hypotension without a strict predefined haemodynamic threshold

Cite This Study

Rousseleau et al. (2026) conducted an observational in Patients requiring intravenous adrenaline during general anaesthesia (n=591). Intravenous adrenaline was evaluated on Incidence of intravenous adrenaline administration per 1,000 anaesthetic procedures. Intravenous adrenaline during general anaesthesia was administered in 1.07 per 1,000 procedures and was frequently associated with acute haemodynamic adverse events, including severe hypertension in 31% of cases.

synapsesocial.com/papers/69c4ccf7fdc3bde448918b52 https://doi.org/10.1186/s12871-026-03760-9

View Full Paper

Ask AI

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Implication

Warrants caution with IV adrenaline during anaesthesia; extends real-world evidence of haemodynamic risks and leaves mitigation strategies open.

Intravenous adrenaline during general anaesthesia: incidence and adverse events over 11 years

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Intravenous adrenaline during general anaesthesia: incidence and adverse events over 11 years

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

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