Comparing Norepinephrine and Phenylephrine to Prevent Kidney Injury After Major Non-Cardiac Surgery Under General Anesthesia

What this Trial Is About

Researchers are evaluating which vasopressor medication, norepinephrine or phenylephrine, is better at preventing kidney injury and other complications such as heart problems in adults undergoing major noncardiac surgery lasting at least two hours under general anesthesia. Low blood pressure during such surgeries is common and can lead to slower recovery due to kidney injury. This trial is a phase 4, cluster-randomized study conducted across multiple hospitals in North America to compare these two standard medications. In this open-label trial, hospital centers will alternate monthly between using either norepinephrine or phenylephrine as the primary intravenous vasopressor to treat low blood pressure during surgery. Anesthesia providers will administer these drugs by infusion or bolus dosing, adjusting doses to maintain target blood pressure. Providers may use the alternative vasopressor if clinically indicated, and standard care will be provided throughout. Data will be collected automatically from routine electronic health records without extra procedures or tests. Participants involvement requires no additional visits or tests beyond usual care. Researchers will collect de-identified data on kidney function and other outcomes from medical records, focusing on acute kidney injury within 7 days after surgery and major kidney events within 28 days. The trial will continue until about 2028, monitoring these outcomes to determine which vasopressor better supports patient recovery after major surgery.

The Choice of Vasopressor to Prevent Postoperative Acute Kidney Injury After Major Non-Cardiac Surgery