The Effect of Epinephrine, Norepinephrine and Phenylephrine on Intraoperative Hemodynamic Performance (RACE)
Cardiac Output, Low, Cardiac Output, High, Perfusion; Complications
About this trial
This is an interventional prevention trial for Cardiac Output, Low focused on measuring Norepinephrine, Epinephrine, Phenylephrine, Major abdominal surgery, Intraoperative Cardiac Output, Intraoperative Hemodynamic, Intraoperative Perfusion
Eligibility Criteria
Inclusion Criteria:
- ≥ 45 years old
- Scheduled for moderate- to high-risk major open abdominal surgery expected to last at least two hours
- ASA physical status ≥ 2
At least one of the following risk factors:
- Age ≥75years
- History of peripheral arterial disease
- History of coronary artery disease
- History of stroke or transient ischemic attack/Stroke
- History of chronic kidney disease
- Diabetes requiring medical treatment
- Current smoking or history of 15 pack-years
- History of heart failure
- Preoperative high-sensitivity Troponin T ≥14ng.L-1
- Preoperative NT-proBNP ≥200 pg.mL-1
Exclusion Criteria:
- Scheduled for pheochromocytoma surgery
- Scheduled for liver and kidney transplantation
- Requiring preoperative intravenous vasopressor medications
- Contraindications to epinephrine, norepinephrine or phenylephrine per clinical judgement
- Permanent atrial fibrillation
- Preoperative heart rate >110 bpm
Sites / Locations
- Medical University of ViennaRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Active Comparator
Active Comparator
Epinephrine Group
Norepinephrine Group
Phenylephrine Group
Patients in the epinephrine group will receive a continuous infusion containing epinephrine with a concentration of 0.02mg/ml for intraoperative blood pressure management. The infusion will be started with 0.15mL/kg/h and will be titrated to receive a mean arterial pressure of at least 75mmHg.
Patients in the norepinephrine group will receive a continuous infusion containing norepinephrine with a concentration of 0.02mg/ml for intraoperative blood pressure management. The infusion will be started with 0.15mL/kg/h and will be titrated to receive a mean arterial pressure of at least 75mmHg.
Patients in the phenylephrine group will receive a continuous infusion containing phenylephrine with a concentration of 0.2mg/ml for intraoperative blood pressure management. The infusion will be started with 0.15mL/kg/h and will be titrated to receive a mean arterial pressure of at least 75mmHg.