Haemodynamic Changes After Prophylactic Doses of Ephedrine, Phenylephrine, Norepinephrine Versus Placebo During Induction of General Anaesthesia: A Randomised Trial
An erratum to this article was published (Acta Anaesthesiol Scand, Jan 2026 ↗)
Authors' conclusion
Prophylactic administration of ephedrine effectively maintained SAP, HR, and CO within the first 5 min following bolus injection at induction with propofol and remifentanil. In contrast, bolus administration of norepinephrine and phenylephrine demonstrated a short duration of action, with SAP comparable to placebo at 5 min.
Study context
- Population
- Healthy women scheduled for gynaecological surgery, Day Surgery Unit, Haugesund Hospital, Norway; Target-controlled infusion (TCI) propofol and remifentanil induction1:1:1:1 allocation
- Participants
- 128 women
- Comparison
- Prophylactic ephedrine, phenylephrine or norepinephrine vs placebo at induction of GA
- Primary endpoint
- Maximal decrease in SAP and HR after bolus administration
- Follow-up
- Within 5 min
Methodological detailsdouble-blind, dose-controlled, single-centre
- Double-blind
- Dose-controlled
- Single-centre
Primary result
As reported in the abstract
Ephedrine
−27
mean · SD 8.9 · mmHg
Phenylephrine
−40
mean · SD 11 · mmHg
Norepinephrine
−41
mean · SD 13 · mmHg
Placebo
−42
mean · SD 10 · mmHg
Secondary outcomes
| Outcome | Ephedrine | Phenylephrine | Norepinephrine | Placebo |
|---|---|---|---|---|
| Maximal HR change (absolute; co-primary) · within 5 minMedian, bpm | −10 (IQR −6.2–-18) | −19 (IQR −17–-26) | −23 (IQR −20–-33) | −15 (IQR −9.5–-21) |
| Relative change | −17% | −30% | −37% | −22% |
| CO changeMean | −22% (SD 11%) | −38% (SD 7.8%) | −42% (SD 9.8%) | — not stated in the abstract |
— not stated in the abstract
Cardiac output (CO) change
- CO best preserved with ephedrine
Stroke volume (SV) change
- Differences between groups small
Systemic vascular resistance (SVR) change
- Largest increase with norepinephrine, then phenylephrine, smallest with ephedrine
Original publication
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