Norepinephrine versus phenylephrine for treating hypotension during general anaesthesia in adult patients undergoing major noncardiac surgery: a multicentre, open-label, cluster-randomised, crossover, feasibility, and pilot trial

Legrand, Matthieu; Kothari, Rishi; Fong, Nicholas; Palaniappa, Nandini; Boldt, David H.; Chen, Lee‐lynn; Kurien, Philip A.; Gabel, Eilon; Sturgess-DaPrato, Jillene; Harhay, Michael O.; Pirracchio, Romain; Bokoch, Michael P.

doi:10.1016/j.bja.2023.02.004

Cited by 7 publications

(2 citation statements)

References 26 publications

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“…Pursuing this goal could paradoxically lead to opposite results: fluids and venous congestion have potentially negative effects on kidney function. Liberal use of vasopressors could expose to higher risk of AKI [10] and implies greater recourse to invasive monitoring methods which may have harmful consequences [11].…”

Section: Association Between Perioperative Hypotension and Akimentioning

confidence: 99%

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Breaking Down the Evidence: Does Perioperative Hypotension Cause Kidney Injury?

Antonucci

Prado

Legrand

2023

Nephron

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Background: Acute kidney injury (AKI) is common in the postoperative period and is associated with negative patient outcomes. The definition of perioperative hypotension is wide, but it is associated with various complications, including AKI. Summary: Preclinical data suggest that sustained severe renal hypoperfusion per se does not cause persistent AKI. The evidence associating blood pressure levels and postoperative renal dysfunction is predominantly retrospective and observational, and therefore potentially misled by the complex interactions between exposures, confounders, and mediators. Key Messages: To better understand how perioperative hemodynamic management could affect the occurrence of kidney injury, it is pivotal to further investigate the association between hypotension and kidney dysfunction in the perioperative period and determine the degree to which hypotension is a causal factor.

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Section: Association Between Perioperative Hypotension and Akimentioning

confidence: 99%

“…Fluid balance and renal function are connected by a u-shaped relationship in the perioperative setting [11]. Fluid overload can compromise renal perfusion via an augmented backpressure mechanism, venous congestion, enhanced atrial natriuretic peptides signaling, and vascular endothelial damage [10].…”

Section: Alternative Injury Mechanismsmentioning

confidence: 99%