Journal of clinical anesthesia · 2025
Anti-inflammatory and anti-nociceptive effects of individualized blood pressure strategy based on low-dose noradrenaline infusion in elderly patients following major surgery: A randomized, controlled study.
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Fang Zheng, Wang Yu-Jie, Zhu Xiao-He, Zheng Jia-Hui, Liu Wei, Gu Erwei, Cheng Xin-Qi
Аннотация
STUDY OBJECTIVE: To determine whether an individualized blood pressure strategy based on low-dose noradrenaline infusion could reduce cytokines/stress level, thus reducing the acute kidney injury (AKI) complication.
DESIGN: A prospective, randomized, controlled trial.
SETTING: The study was performed in First Affiliated Hospital of Anhui Medical University, China, from December 2021 to July 2023.
PATIENTS: 108 patients older than 60 years with ASA class II-III and scheduled to hepatobiliary and pancreatic surgery were enrolled.
INTERVENTION: Patients were randomly assigned in a 1:1 ratio to either a standard or individualized treatment group. Individualized management strategy aimed at achieving a mean arterial pressure (MAP) within 20 % of the reference value or standard management strategy of treating MAP less than 65 mmHg.
MEASUREMENTS: The primary outcome was tumor necrosis factor-α (TNF-α) at 24 h after surgery. The secondary outcomes included other inflammatory cytokine IL-6 and IL-10 levels and the incidence of postoperative AKI within 7-day after surgery.
MAIN RESULTS: 100 patients completed the trial and were included in the modified intention-to-treat analysis. The primary outcome TNF-α at 24 h was increased to 16.65 (7.36) pg/ml assigned to the individualized treatment strategy vs 21.23 (7.70) pg/ml in standard treatment group (difference -4.58, 95 %CI -7.56 to -1.58, P = 0.003). A relatively mild increase from baseline were found after surgery in IL-6 and cortisol level except for IL-10. 3 patients (6 %) in the individualized treatment group and 10 (20 %) in the standard treatment group had AKI (Relative Risk 3.33; 95 % CI, 0.95 to 11.39; P = 0.037).
CONCLUSION: Among elderly patients undergoing major surgery, an individualized mean arterial pressure strategy management based on low-dose norepinephrine reduced surgical stress responses and attenuated the release of proinflammatory cytokines TNF-α and IL-6. It was also associated with a lower risk of AKI.
DESIGN: A prospective, randomized, controlled trial.
SETTING: The study was performed in First Affiliated Hospital of Anhui Medical University, China, from December 2021 to July 2023.
PATIENTS: 108 patients older than 60 years with ASA class II-III and scheduled to hepatobiliary and pancreatic surgery were enrolled.
INTERVENTION: Patients were randomly assigned in a 1:1 ratio to either a standard or individualized treatment group. Individualized management strategy aimed at achieving a mean arterial pressure (MAP) within 20 % of the reference value or standard management strategy of treating MAP less than 65 mmHg.
MEASUREMENTS: The primary outcome was tumor necrosis factor-α (TNF-α) at 24 h after surgery. The secondary outcomes included other inflammatory cytokine IL-6 and IL-10 levels and the incidence of postoperative AKI within 7-day after surgery.
MAIN RESULTS: 100 patients completed the trial and were included in the modified intention-to-treat analysis. The primary outcome TNF-α at 24 h was increased to 16.65 (7.36) pg/ml assigned to the individualized treatment strategy vs 21.23 (7.70) pg/ml in standard treatment group (difference -4.58, 95 %CI -7.56 to -1.58, P = 0.003). A relatively mild increase from baseline were found after surgery in IL-6 and cortisol level except for IL-10. 3 patients (6 %) in the individualized treatment group and 10 (20 %) in the standard treatment group had AKI (Relative Risk 3.33; 95 % CI, 0.95 to 11.39; P = 0.037).
CONCLUSION: Among elderly patients undergoing major surgery, an individualized mean arterial pressure strategy management based on low-dose norepinephrine reduced surgical stress responses and attenuated the release of proinflammatory cytokines TNF-α and IL-6. It was also associated with a lower risk of AKI.