Management of Post-Induction Hypotension in Emergency Abdominal Surgery

Summary

The goal of this clinical trial is to compare the efficacy of two vasopressors (norepinephrine vs. ephedrine) in treating hypotension in adult patients (aged 18+, ASA I-III) undergoing general anesthesia for abdominal surgical emergencies (e.g., appendicitis, intestinal obstruction, peritonitis). The main questions it aims to answer are: * Which drug is more effective at maintaining intraoperative blood pressure (SBP ≥ 80% of baseline)? * How many boluses of each vasopressor are required to maintain target blood pressure? Researchers will compare the norepinephrine group (receiving 10 µg boluses) to the ephedrine group (receiving 6 mg boluses) to see if norepinephrine is superior for maintaining hemodynamic stability and reduces the number of interventions needed. Participants will: * Be randomly assigned to receive one of the two study drugs. * Undergo standard general anesthesia with close hemodynamic monitoring. * Receive boluses of the assigned vasopressor whenever their blood pressure drops below a predefined threshold.

Timeline

Start

2025-03-06

Primary completion

2025-05-06

Completion

2025-05-06

Publications

• Background Fathy MM, Wahdan RA, Salah AAA, Elnakera AM. Inferior vena cava collapsibility index as a predictor of hypotension after induction of general anesthesia in hypertensive patients. BMC Anesthesiol. 2023 Dec 19;23(1):420. doi: 10.1186/s12871-023-02355-y.
• Background Hassani V, Movaseghi G, Safaeeyan R, Masghati S, Ghorbani Yekta B, Farahmand Rad R. Comparison of Ephedrine vs. Norepinephrine in Treating Anesthesia-Induced Hypotension in Hypertensive Patients: Randomized Double-Blinded Study. Anesth Pain Med. 2018 Aug 26;8(4):e79626. doi: 10.5812/aapm.79626. eCollection 2018 Aug.
• Background Ali Elnabtity AM, Selim MF. Norepinephrine versus Ephedrine to Maintain Arterial Blood Pressure during Spinal Anesthesia for Cesarean Delivery: A Prospective Double-blinded Trial. Anesth Essays Res. 2018 Jan-Mar;12(1):92-97. doi: 10.4103/aer.AER_204_17.
• Background Ngan Kee WD, Lee SWY, Ng FF, Khaw KS. Prophylactic Norepinephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery. Anesth Analg. 2018 Jun;126(6):1989-1994. doi: 10.1213/ANE.0000000000002243.
• Background Wong GTC, Irwin MG. Post-induction hypotension: a fluid relationship? Anaesthesia. 2021 Jan;76(1):15-18. doi: 10.1111/anae.15065. Epub 2020 Jul 1. No abstract available.
• Background Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007 Aug;107(2):213-20. doi: 10.1097/01.anes.0000270724.40897.8e.

Drugs

Indications