Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
October 30, 2020Korean Journal of AnesthesiologyOpen Access

Prophylactic norepinephrine maintains better cardiac output and an ~11 bpm higher heart rate versus phenylephrine.

View Full Paper
Ask AI
Bookmark
Share

Why the study?

Elderly patients are at increased risk of spinal anesthesia-induced hypotension, which raises postoperative morbidity and mortality.

Does norepinephrine infusion compared to phenylephrine infusion improve hemodynamic stability in elderly patients undergoing hip fracture surgery under spinal anesthesia?

Comparison

Norepinephrine infusion (8 µg/min) vs phenylephrine infusion (100 µg/min)

Design

Randomized controlled trial

Key result

Prophylactic norepinephrine infusion maintained a significantly higher mean heart rate (79 vs 68 beats/min, P<0.001) and cardiac output compared to phenylephrine in elderly patients undergoing hip fracture surgery.

Authors

MMMaha MostafaMMMaha MostafaAHAhmed Hasanin

Discussion

Loading...

Member takes

Overview

Supports norepinephrine over phenylephrine to preserve heart rate and cardiac output in elderly hip fracture surgery under spinal anesthesia; extends RCT evidence for vasopressor selection.

Study Design

Type

RCT (n=62)

Blinding

Double-blind

Randomization

1:1 ratio using a computer-generated random sequence and concealed envelopes

Multicenter

No

Structured PICO

Does norepinephrine infusion compared to phenylephrine infusion improve hemodynamic stability in elderly patients undergoing hip fracture surgery under spinal anesthesia?

P
Population
62 elderly adults (mean age 71, 47% female) without severe cardiac abnormalities undergoing hip fracture surgery under spinal anesthesia, monitored intraoperatively.
I
Intervention
Norepinephrine infusion (8 µg/min) after spinal anesthesia
C
Comparator
Phenylephrine infusion (100 µg/min) after spinal anesthesia
O
Outcome
Hemodynamic effects including mean heart rate, mean blood pressure, cardiac output, incidence of spinal anesthesia-induced hypotension, incidence of bradycardia, and incidence of hypertensionsurrogate

Main Result

Absolute Event Rate: 79% vs 68%

p-value: p=<0.001

Prophylactic norepinephrine infusion provides better hemodynamic stability with less reactive bradycardia and hypertension compared to phenylephrine in elderly patients undergoing hip fracture surgery under spinal anesthesia.

Limitations

  • Single-center study
  • Excluded patients with cardiac comorbidities
  • Equipotent dose chosen based on obstetric population data rather than elderly population data
  • Cardiac output was assessed noninvasively using electric cardiometry, which may not be interchangeable with the thermodilution method

Cite This Study

Mostafa et al. (2020) conducted an RCT in Spinal anesthesia-induced hypotension in hip fracture surgery (n=62). Norepinephrine vs. Phenylephrine (100 µg/min infusion) was evaluated on Mean heart rate during vasopressor infusion (p=<0.001). Prophylactic norepinephrine infusion maintained a significantly higher mean heart rate (79 vs 68 beats/min, P<0.001) and cardiac output compared to phenylephrine in elderly patients undergoing hip fracture surgery.

synapsesocial.com/papers/6aaa687b561c8ccf3ff293efhttps://doi.org/10.4097/kja.20519
View Full Paper
Ask AI
Bookmark
Share

Also Consider

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

  1. 1Comparison of the effect of different doses of phenylephrine infusion on the prevention of hypotension in the elderly under spinal anaesthesia in orthopaedic surgery2024
  2. 2Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery2016 · 13 citations
  3. 3Norepinephrine infusion for prophylaxis against spinal-induced hypotension in elderly patients undergoing hip surgery: a randomized controlled comparison of two doses2026
  4. 4Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: a randomized controlled trial2023 · 11 citations
  5. 5A Comparative Study of Infusion of Ephedrine and Phenylephrine on Hemodynamic Stability After Spinal Anesthesia in Elderly Patients Undergoing Lower Limb Orthopedic Surgeries2024 · 4 citations