Key result
Norepinephrine versus phenylephrine as first-line vasopressor during general anaesthesia achieved 88.2% overall compliance, with no difference in 30-day readmission (OR 0.92; 95% CI 0.6-1.39).
Why the study?
Intraoperative hypotension is associated with postoperative complications and vasopressors are often required to correct it, but the best vasopressor is unknown.
Does norepinephrine compared to phenylephrine improve clinical outcomes in adult patients undergoing major noncardiac surgery under general anaesthesia?
RCT (n=3,626)
Open-label
Cluster-randomized, crossover
Yes
Does norepinephrine compared to phenylephrine improve clinical outcomes in adult patients undergoing major noncardiac surgery under general anaesthesia?
A cluster-randomized trial demonstrated the feasibility of randomizing first-line vasopressors (norepinephrine vs phenylephrine) during noncardiac surgery, though it was underpowered to detect differences in clinical outcomes.
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High compliance supports feasibility of vasopressor randomisation in noncardiac surgery; leaves open effects on clinical outcomes.
Legrand et al. (2023) conducted an RCT in Hypotension during general anaesthesia in adult patients undergoing major noncardiac surgery (n=3,626). Norepinephrine infusion vs. Phenylephrine infusion was evaluated on First-line vasopressor administration compliance of 80% or higher. Norepinephrine versus phenylephrine as first-line vasopressor during general anaesthesia achieved 88.2% overall compliance, with no difference in 30-day readmission (OR 0.92; 95% CI 0.6-1.39).
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