Prophylactic Norepinephrine Infusion Reduces Postoperative Complications and Hospitalization Time in Elderly Patients Undergoing Posterior Lumbar Spinal Fusion.

Tao Liang,Fan Wu,Jianshe Yu,Yaying Xie,Libiao Li,Claudia Loardi

doi:10.1155/2021/2161036

Abstract

This single-center prospective randomized controlled trial explores the effect of prophylactic norepinephrine infusion on the incidence of complications and hospitalization time in elderly patients (60-85 years old) undergoing posterior lumbar spinal fusion. In total, 129 elderly patients were randomized into two groups: a group that received norepinephrine during general anesthesia and a control group not receiving norepinephrine. The primary outcomes were in-hospital complications and 90-day postoperative complications and hospitalization time. The results show that in-hospital complications occurred in 24 of 60 patients (40%) in the control group versus 11 of 60 patients (18.3%) in the norepinephrine group (RR, 2.182; 95% CI, 1.177–4.045; P = 0.015). Cardiac events occurred significantly more frequently in the control than in the norepinephrine group. Total number of patients experiencing complications within 90 days postoperatively was lower in the norepinephrine (11 of 60; 18.3%) than in the control group (26 of 60; 43.3%; RR, 2.364; 95% CI, 1.288–4.339; P = 0.005). The median length of hospital stay was 17 days (11–27) in the control group and 15 days (10– 23) in the norepinephrine group (P = 0.01). The secondary outcomes were serum levels of syndecan-1, hyaluronic acid, heparan sulfate, and brain natriuretic peptide. Logistic regression analysis is used to describe the relationship between selected independent variables and in-hospital complications. Intraoperative total fluid, crystalloid, and colloid volumes were significantly higher in the control than in the norepinephrine group. The patients in the norepinephrine group had a higher MAP but a lower heart rate than those in the control group after the induction of anesthesia and intraoperatively. Syndecan-1, hyaluronic acid, and heparan sulfate serum levels showed a different course in the two groups. In conclusion, prophylactic norepinephrine infusion during posterior lumbar spinal fusion is preferable for elderly patients undergoing lumbar spinal fusion under general anesthesia. It can reduce postoperative complications and hospitalization time by reducing the injury to the vascular endothelium. This trial is registered with Clinical Trial Registration http://www.chictr.org.cn/showproj.aspx?proj=33660, identifier ChiCTR-1900021309.

Highlights

Fluid resuscitation is considered standard of the operating room (OR)
The patients in the norepinephrine group had a higher mean arterial pressure (MAP) compared to the control group at the Tb (P < 0:01) and the surgical incision (Tc) time points (P < 0:01) but a lower heart rate
There was no significant difference between the two groups in the Pulse pressure variation (PPV) at any time point (P > 0:05) (Table 2)

Summary

Introduction

Fluid resuscitation is considered standard of the operating room (OR). More and more people were aware of the adverse effects of fluid administration [1]. Fluid challenge administration was associated with increased perfused boundary region (and presumable volume changes of the endothelial glycocalyx) [2]. The degradation of glycocalyx was strongly associated with in-hospital mortality. This finding suggests a mechanism about intravenous fluid resuscitation strategies may lead to iatrogenic endothelial injury [3]. A better understanding of the determinants of vascular permeability is a trend about fluid resuscitation, and perhaps in the future, the identification of the endothelial glycocalyx as a possible therapeutic target [4]

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