Effective dose of ephedrine for treatment of hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age: a multicentre randomised, controlled, open label, dose escalation trial

Szostek, A. S.; Saunier, Clarisse; Elsensohn, Mad-Hélénie; Boucher, Pierre; Merquiol, F.; Gerst, A.; Portefaix, Aurélie; Chassard, D.; Siqueira, Mathilde De Queiroz

doi:10.1016/j.bja.2022.12.006

Cited by 6 publications

(3 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…BMI was related to the changes in CO after the administration of ephedrine, possibly because the ephedrine dose was determined based on body weight. Previous studies have shown the dose-dependent effect of ephedrine [ 22 , 23 ]. Preoperative administration of oral rehydration solution showed no significant impact on the pressor effect of ephedrine.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic impact of ephedrine on hypotension during general anesthesia: a prospective cohort study on middle-aged and older patients

Uemura,

Kinoshita,

Sakai

et al. 2023

BMC Anesthesiol

View full text Add to dashboard Cite

Background Ephedrine is a mixed α- and β-agonist vasopressor that is frequently used for the correction of hypotension during general anesthesia. β-responsiveness has been shown to decrease with age; therefore, this study aimed to determine whether aging would reduce the pressor effect of ephedrine on hypotension during general anesthesia. Methods Seventy-five patients aged ≥ 45 years were included in this study, with 25 patients allocated to each of the three age groups: 45–64 years, 65–74 years, and ≥ 75 years. All patients received propofol, remifentanil, and rocuronium for the induction of general anesthesia, followed by desflurane and remifentanil. Cardiac output (CO) was estimated using esCCO technology. Ephedrine (0.1 mg/kg) was administered for the correction of hypotension. The primary and secondary outcome measures were changes in the mean arterial pressure (MAP) and CO, respectively, at 5 min after the administration of ephedrine. Results The administration of ephedrine significantly increased MAP (p < 0.001, mean difference: 8.34 [95% confidence interval (CI), 5.95–10.75] mmHg) and CO (p < 0.001, mean difference: 7.43 [95% CI, 5.20–9.65] %) across all groups. However, analysis of variance revealed that the degree of elevation of MAP (F [2, 72] = 0.546, p = 0.581, η2 = 0.015 [95% CI, 0.000–0.089]) and CO (F [2, 72] = 2.023, p = 0.140, η2 = 0.053 [95% CI, 0.000–0.162]) did not differ significantly among the groups. Similarly, Spearman’s rank correlation and multiple regression analysis revealed no significant relation between age and the changes in MAP or CO after the administration of ephedrine. Conclusion The administration of ephedrine significantly increased MAP and CO; however, no significant correlation with age was observed in patients aged > 45 years. These findings suggest that ephedrine is effective for the correction of hypotension during general anesthesia, even in elderly patients. Trial registration UMIN-CTR (UMIN000045038; 02/08/2021).

show abstract

Section: Discussionmentioning

confidence: 99%

Hemodynamic impact of ephedrine on hypotension during general anesthesia: a prospective cohort study on middle-aged and older patients

Uemura,

Kinoshita,

Sakai

et al. 2023

BMC Anesthesiol

View full text Add to dashboard Cite

show abstract

“…The difficulties identifying an optimal dose of ephedrine in small children have been recently reported. 23 , 24 In these populations, blood pressure corrections should be carefully handled as fluid overload or inotrope-induced hypertension can also have catastrophic consequences such as pulmonary oedema or cerebral haemorrhages. 23 , 25 …”

Section: Cerebral Blood Flow: Physiology Management and Outcomesmentioning

confidence: 99%

“…A final issue is the blood pressure target. Is it, as in adults, a decrease to 20% below the baseline value, 23 , 24 or maybe a combination of multiple elements, including those provided by NIRS or the NeoDoppler? 26 Once again, further research will be necessary to establish goal-directed fluid and inotropic therapy in these young and vulnerable patients undergoing noncardiac procedures.…”

Section: Cerebral Blood Flow: Physiology Management and Outcomesmentioning

confidence: 99%