ArticleAnesthesia and pain medicine2026
Prophylactic infusion of norepinephrine enhances hemodynamic stability during propofol induction and early intubation period in elderly patients: a double-blind randomized placebo-controlled trial.
Article in Anesthesia and pain medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The induction of general anesthesia with propofol often results in hypotension, which is primarily attributed to a decrease in the cardiac index (CI) among elderly patients. Norepinephrine (NE) is typically used to manage anesthesia-induced hypotension. We hypothesized that NE attenuates the reduction in CI while preserving blood pressure. Methods: In a randomized, double-blinded trial, 60 elderly patients undergoing elective major abdominal surgery under general anesthesia were randomly allocated to receive infusion of NE (6 µg/ml) (NE group) or saline (control [CT] group) during induction. CI was monitored using the FloTrac/Vigileo system, and the primary outcome was the change in CI (△CI) (△Value = value measured at the study time point-baseline value) at 10 min post-intubation (T10). Additionally, changes in systemic vascular resistance index (△SVRI) and mean arterial pressure (△MAP) were also evaluated for comparison. Results: In the NE group, the CI decreased from 3.9 to 2.9 L·min-1/m-2 at 10 min post-intubation (T10), whereas in the CT group, it declined from 3.7 to 2.6 L·min-1/m-2. After adjusting for propofol dosage per weight, the decreases in △CI (β = 0.63, 95% confidence interval [CI] 0.18 to 1.07; P = 0.006) and △MAP (β = 11.99, 95% CI 2.05 to 21.94; P = 0.018) at T10 were significantly less in the NE group compared to the CT group, whereas △SVRI did not show a significant difference between the two groups. From induction until 10 min post-intubation, the reductions in △CI, △MAP and stroke volume (△SV) were attenuated, and stroke volume variation was lower, while △SVRI and pulse rate (△PR) remained comparable between the NE and CT groups. Conclusions: Prophylactic infusion of NE effectively attenuated the decrease in △CI during propofol-induced anesthesia in elderly patients while maintaining MAP.
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