Comparing Noradrenaline Infusion to Standard Blood Pressure Management to Prevent Low Blood Pressure During and After Non-Heart Surgery

What this Trial Is About

This research aims to evaluate whether infusing noradrenaline around the time of non-cardiac surgery can better prevent low blood pressure hypotension compared to standard blood pressure management. The study focuses on patients aged 45 and older undergoing elective or accelerated non-cardiac surgery lasting at least one hour. It investigates if noradrenaline infusion reduces episodes of low blood pressure during and up to four hours after surgery, and whether it lowers risks of postoperative organ problems or complications. Participants will be randomly assigned to one of two groups. One group receives a noradrenaline infusion starting shortly before anesthesia induction, maintained during surgery and up to four hours after, with careful dose adjustments to maintain stable blood pressure. The other group receives standard blood pressure management, reacting to low blood pressure using ephedrine boluses or noradrenaline as needed, following current guidelines. All patients receive balanced fluids during surgery and standard ventilatory support. Blood pressure is continuously monitored using a non-invasive volume-clamp method, while clinical teams use routine measurements for care decisions. During the study, participants will have their blood pressure closely tracked during surgery and in the recovery area. Researchers will assess occurrences of low blood pressure during and up to four hours after surgery, as well as various postoperative complications including heart injury, kidney injury, stroke, cardiac arrest, sepsis, and death, monitored up to 30 days after surgery. Safety assessments include reactions related to the noradrenaline infusion. Participants are expected to stay overnight in the hospital, and the study ensures careful monitoring of hemodynamic stability throughout the perioperative period.

Noradrenaline Versus Standard Blood Pressure Management for Perioperative Hypotension in Non-cardiac Surgery