Continuous Versus Bolus Norepinephrine Administration to Treat Postinduction Hypotension
This study, called INDUCT-Multi, is looking at how a medicine called norepinephrine is given during operations. Norepinephrine helps keep blood pressure stable. We want to find out if giving it continuously, rather than in small, quick doses (boluses), can reduce a common problem called 'post-induction hypotension'. This is when blood pressure drops too low right after you've been given medicine to make you sleep for surgery. It's important because low blood pressure can sometimes lead to kidney problems. This research focuses on people having non-heart surgery who are considered to be at higher risk of their blood pressure dropping. They will already have their blood pressure closely monitored during the operation.
At a glance
What is this study about?
When you have a general anaesthetic for an operation, your blood pressure can sometimes drop too low shortly after you've been given the medicines to make you go to sleep. This is called 'post-induction hypotension', and it's quite common, especially for people having surgery that isn't on their heart. If your blood pressure stays too low for too long, it can sometimes cause issues like temporary kidney problems. Doctors use special equipment to keep a close eye on your blood pressure during surgery, and they often give medicines to help keep it stable.
One common medicine used is called norepinephrine. It works quickly to raise blood pressure and its effects don't last very long. Usually, doctors give this medicine in small, quick doses (called 'boluses') whenever your blood pressure starts to dip. However, they need to be very careful with the timing and how often they give these pushes to make sure your blood pressure stays level.
We've done some earlier research that suggested giving norepinephrine as a continuous, steady drip might be better at keeping blood pressure stable than giving it in these sudden pushes. So, in this new study, INDUCT-Multi, we want to find out if giving norepinephrine continuously actually helps to stop post-induction hypotension from happening as often, or makes it less severe, in people having non-heart surgery who are at risk of blood pressure problems.
Key takeaways
- This study compares two ways of giving blood pressure medicine (norepinephrine) during surgery.
- It aims to find out if continuous delivery is better at preventing low blood pressure than giving it in quick pushes.
- The study focuses on people having non-heart surgery who are at higher risk of blood pressure drops.
- Participation will not involve any extra tests or appointments beyond your standard surgical care.
- Results from this study could help improve how blood pressure is managed during operations in the future.
Who may be eligible?
This study is looking for people aged 45 or older who are having a planned, major operation that is not on their heart. You'd be having a general anaesthetic and, as part of your normal care, doctors would already be planning to keep a very close eye on your blood pressure during the surgery using a special tiny tube in your wrist artery. Everyone taking part must also be able to understand the study information and give their permission to join.
To be eligible, you also need to have at least two of the following risk factors: being 65 or older; having a certain health status (ranked as ASA III or IV); having long-term high blood pressure; having diabetes that you take medicine for; having surgery on your tummy; or having some existing kidney issues before your operation.
There are some reasons why you couldn't join. These include if you are pregnant, have certain heart rhythm problems, have a history of bleeding or swelling in the brain, or if your doctor already feels you need a continuous norepinephrine drip during surgery for a specific health condition (like severe heart valve problems or heart failure). You also need to be able to understand the study information and consent form in German.
Could this study suit you?
Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.
- Are you 45 years old or older?
- Are you having a major operation that is NOT on your heart?
- Will you be having general anaesthesia and constant blood pressure monitoring with a tiny tube in your wrist?
- Do you have at least two of these: Aged 65+, specific health status (ASA III/IV), long-term high blood pressure, diabetes treated with medicine, surgery on your tummy, or some existing kidney issues?
- Are you not pregnant and do not have certain heart rhythm or brain conditions?
- Can you understand information about the study in German?
What does participation involve?
If you decide to take part in this study, you will be randomly assigned to one of two groups, like flipping a coin. You won't get to choose which group you're in. One group will receive norepinephrine as a continuous drip during your anaesthetic, and the other group will receive it as small, quick doses (boluses) if needed. You will have all the usual monitoring and care for your type of surgery, including constant blood pressure monitoring through a tiny tube in your wrist. The doctors and nurses looking after you during surgery will know which treatment you are receiving, but the study team who analyse the results will not know. After your surgery, the study team will collect information about your immediate recovery, particularly focusing on your kidney function. There are no extra visits or assessments beyond your standard hospital care; all information is gathered from your routine medical records.
Potential risks and benefits
Locations (4)
- Department of Anesthesiology, University Hospital Duesseldorf, Heinrich Heine University DuesseldorfVerified postcodeDüsseldorf, Germany· Recruiting
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University GiessenVerified postcodeGiessen, Germany· Not yet recruiting
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-EppendorfVerified postcodeHamburg, Germany· Not yet recruiting
- Department of Anaesthesiology, University Hospital LMU MunichVerified postcodeMünchen, Germany· Recruiting
Common questions
What is post-induction hypotension?
It's when your blood pressure drops too low shortly after you've been given medicine to go to sleep for an operation.
What is norepinephrine?
It's a medicine often used during surgery to help raise and keep blood pressure steady.
Will I know if I'm getting continuous or bolus norepinephrine?
No, you won't know which method is being used; it's decided randomly, like tossing a coin.
Will this study involve extra doctor's appointments for me?
No, all information for the study will be collected from your normal hospital care and records; there are no extra appointments.
Can I leave the study at any time?
Yes, you can decide to stop participating in the study at any point without it affecting your medical care.
How to find out more
Kristen K Thomsen, MD
Always speak to your GP or specialist before deciding to take part in a study.
Interested in taking part?
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