Trial reportBritish journal of anaesthesia2021
Automated closed-loop versus manually controlled norepinephrine infusion in patients undergoing intermediate- to high-risk abdominal surgery: a randomised controlled trial.
Trial report in British journal of anaesthesia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04089644 (Physician-Directed vs Computer-Assisted Norepinephrine Administration in Patients Undergoing Major Abdominal Surgery), which is not on this map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Physician-Directed vs Computer-Assisted Norepinephrine Administration in Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 55 citations in OpenAlex.
- Closed-loop vasopressor systems for hemodynamic control in perioperative and critical care settings: a systematic review and meta-analysis.Journal of clinical monitoring and computing · 2026Pooled it
- Performance of closed-loop systems for intravenous drug administration: a systematic review and meta-analysis of randomised controlled trials.Journal of clinical monitoring and computing · 2024Pooled it
- Population Pharmacokinetic Modelling of Norepinephrine in Healthy Volunteers Prior to and During General Anesthesia.Clinical pharmacokinetics · 2024Trial
- Tight control of mean arterial pressure using a closed loop system for norepinephrine infusion after high-risk abdominal surgery: a randomized controlled trial.Journal of clinical monitoring and computing · 2024Trial
- Control of mean arterial pressure using a closed-loop system for norepinephrine infusion in severe brain injury patients: the COMAT randomized controlled trial.Journal of clinical monitoring and computing · 2024Trial
- Effect of intravenous low-dose norepinephrine on blood loss in non-tourniquet total knee arthroplasty under general anesthesia: a randomized, double-blind, controlled, single-center trial.Journal of orthopaedic surgery and research · 2023Trial
- Computer-assisted Individualized Hemodynamic Management Reduces Intraoperative Hypotension in Intermediate- and High-risk Surgery: A Randomized Controlled Trial.Anesthesiology · 2021Trial
- Closed-loop vasopressor systems: surrogate benefit, heterogeneous targets, and uncertain generalisability.Journal of clinical monitoring and computing · 2026Article
- Cerebral hemodynamics, autoregulation, and neurocognitive outcomes during Trendelenburg positioning in robot-assisted abdominopelvic surgery: a narrative review.Journal of robotic surgery · 2026Review
- Artificial Intelligence-Driven Norepinephrine Control Using Adaptive Cardiac Digital Twin for Critical Care Patients.Methods of information in medicine · 2026Article
- Monitoring Inputs, Control Architectures, and Failure Modes in Closed-Loop Vasopressor Systems: A Comprehensive Review.Sensors (Basel, Switzerland) · 2026Review
- Perioperative Vasopressor Management in Noncardiac Surgical Patients.Anesthesiology · 2026Article
- Intraoperative blood pressure management in noncardiac surgery: a narrative review based on current evidence.Intensive care medicine · 2026Review
- Prediction of surgery start for automated anesthesia using draping detection from surveillance videos.Journal of clinical monitoring and computing · 2026Article
- Goal-directed therapy: what is the goal again?Perioperative medicine (London, England) · 2025Review
- MAN VERSUS MACHINE: PROVIDER DIRECTED VERSUS PRECISION AUTOMATED CRITICAL CARE MANAGEMENT IN A PORCINE MODEL OF DISTRIBUTIVE SHOCK.Shock (Augusta, Ga.) · 2024Article
- Artificial Intelligence in Perioperative Planning and Management of Liver Resection.Indian journal of surgical oncology · 2024Review
- Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine.Journal of clinical monitoring and computing · 2024Review
- Closing the loop: automation in anesthesiology is coming.Journal of clinical monitoring and computing · 2024Article
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundHypotension occurs frequently during surgery and may be associated with adverse complications. Vasopressor titration is frequently used to correct hypotension, but requires considerable time and attention, potentially reducing the time available for other clinical duties. To overcome this issue, we have developed a closed-loop vasopressor (CLV) controller to help correct hypotension more efficiently. The aim of this randomised controlled study was to evaluate whether the CLV controller was superior to traditional vasopressor management at minimising hypotension in patients undergoing abdominal surgery.
methodsThirty patients scheduled for elective intermediate-to high-risk abdominal surgery were randomised into two groups. In the CLV group, hypotension was corrected automatically via the CLV controller system, which adjusted the rate of a norepinephrine infusion according to MAP values recorded using an advanced haemodynamic device. In the control group, management of hypotension consisted of standard, manual adjustment of the norepinephrine infusion. The primary outcome was the percentage of time that a patient was hypotensive, defined as MAP <90% of their baseline value, during surgery.
resultsThe percentage of time patients were hypotensive during surgery was 10 times less in the CVL group than in the control group (1.6 [0.9-2.3]% vs 15.4 [9.9-24.3]%; difference: 13 [95% confidence interval: 9-19]; P<0.0001). The CVL group also spent much less time with MAP <65 mm Hg (0.2 [0.0-0.4]% vs 4.5 [1.1-7.9]%; P<0.0001).
conclusionsIn patients undergoing intermediate- to high-risk surgery under general anaesthesia, computer-assisted adjustment of norepinephrine infusion significantly decreases the incidence of hypotension compared with manual control. CLINICAL
trial registrationNCT04089644.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.