Mayo Clinic
The purpose of this research is to compare two commonly used medications, phenylephrine and norepinephrine, that are used to treat low blood pressure during complex spine surgery. The goal is to determine whether one medication better maintains blood flow to the body's organs during surgery and whether it leads to better recovery and fewer complications after surgery.
Inclusion Criteria: * Scheduled for elective complex spine surgery including posterior fusion of 5 or more levels of the thoracic and/or lumbar region. * ASA physical status classification I-III. * Able to provide informed consent. Exclusion Criteria: * Known allergies or contraindication to NE or PE. * Pregnant or breastfeeding women. * Emergency surgeries. * Persistent atrial fibrillation * LVEF \< 40% * Moderate or severe valvular dysfunction * RVSP ≥ 60 mm Hg * Liver failure or cirrhosis * eGFR \< 15 and/or on hemodialysis * Minimally invasive or endoscopic surgeries
Phenylephrine hydrochloride will be prepared at a concentration of 40 mcg/mL and initiated at 0.2 mcg/kg/min. The infusion will be titrated intraoperatively to maintain MAP greater than 85 mmHg from surgical manipulation of vertebrae until final wound closure.
Norepinephrine bitartrate will be prepared at a concentration of 16 mcg/mL, equivalent to 8.47 mcg/mL norepinephrine base, and initiated at 0.02 mcg/kg/min. The infusion will be titrated intraoperatively to maintain MAP greater than 85 mmHg from surgical manipulation of vertebrae until final wound closure.
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