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July 23, 2026Anesthesia and Pain MedicineOpen Access

Prophylactic norepinephrine during propofol induction attenuates the drop in cardiac index vs saline.

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Why the study?

Propofol induction often causes hypotension driven by decreased cardiac index in elderly patients, and whether norepinephrine attenuates this reduction while preserving blood pressure was evaluated.

Does prophylactic infusion of norepinephrine reduce the decrease in cardiac index in elderly patients undergoing elective major abdominal surgery under general anesthesia?

Population

60 elderly patients undergoing elective major abdominal surgery under general anesthesia

Comparison

Norepinephrine infusion (6 µg/ml) vs saline

Design

Randomized double-blind placebo-controlled trial

Follow-up

10 min post-intubation

Key result

Prophylactic infusion of norepinephrine during propofol induction significantly attenuated the decrease in cardiac index compared to saline (β 0.63; 95% CI 0.18-1.07; P=0.006).

Authors

WPWenping PengXSXiaolu SunSZShuang Zhao

Discussion

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Overview

NE preserves CI during propofol induction in elderly surgical patients; extends evidence guiding vasopressor choice in geriatric anesthesia.

Key Points

  • To determine whether norepinephrine infusion can maintain hemodynamic stability during propofol induction in elderly patients.
  • Conducted a randomized, double-blind, placebo-controlled trial with 60 elderly patients undergoing major abdominal surgery.
  • Patients were assigned to receive either norepinephrine or saline during induction of general anesthesia.
  • Cardiac index, mean arterial pressure, and systemic vascular resistance index were monitored.
  • In the NE group, cardiac index decreased by 1.0 L·min–1/m–2, while in the CT group it decreased by 1.1 L·min–1/m–2.
  • Norepinephrine infusion led to significantly less decrease in cardiac index (β = 0.63; P = 0.006) and mean arterial pressure (β = 11.99; P = 0.018) compared to control.
  • No significant difference in systemic vascular resistance index between the NE and CT groups.

Study Design

Type

RCT (n=60)

Blinding

Double-blind

Randomization

Randomized

Structured PICO

Does prophylactic infusion of norepinephrine reduce the decrease in cardiac index in elderly patients undergoing elective major abdominal surgery under general anesthesia?

P
Population
60 elderly patients undergoing elective major abdominal surgery under general anesthesia.
I
Intervention
Prophylactic infusion of norepinephrine (6 µg/ml) during induction
C
Comparator
Infusion of saline (control group) during induction
O
Outcome
Change in cardiac index (△CI) at 10 min post-intubation (T10)surrogate

Main Result

Mean Difference: 0.63 (95% CI 0.18–1.07)

p-value: p=0.006

Prophylactic infusion of norepinephrine effectively attenuates the decrease in cardiac index and maintains mean arterial pressure during propofol-induced anesthesia in elderly patients.

Cite This Study

Peng et al. (2026) conducted an RCT in Elective major abdominal surgery under general anesthesia (n=60). Norepinephrine vs. Saline was evaluated on Change in cardiac index (△CI) at 10 min post-intubation (β 0.63, 95% CI 0.18-1.07, p=0.006). Prophylactic infusion of norepinephrine during propofol induction significantly attenuated the decrease in cardiac index compared to saline (β 0.63; 95% CI 0.18-1.07; P=0.006).

synapsesocial.com/papers/6a61af2ffaa9903c5116a0b1https://doi.org/10.17085/apm.25329
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Causes of arterial hypotension during anesthetic induction with propofol investigated with perfusion index and ClearSightTM in young and elderly patients2021 · 17 citations
  2. 2Hemodynamic effects of norepinephrine versus phenylephrine infusion for prophylaxis against spinal anesthesia-induced hypotension in the elderly population undergoing hip fracture surgery: a randomized controlled trial2020 · 16 citations
  3. 3Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial2023 · 11 citations
  4. 4599: LESSER OF TWO EVILS? PROPOFOL AND HYPOTENSION WITH THE NEED FOR NOREPINEPHRINE2026
  5. 5Preemptive Low-Dose Norepinephrine Infusion for Reducing Hemodynamic Instability During Craniotomy for Brain Tumor Resection Under Propofol–Remifentanil Total Intravenous Anesthesia: A Randomized Controlled Trial2026