Continuous versus bolus norepinephrine during anesthesia induction for postinduction hypotension
Continuous Versus Bolus Norepinephrine Administration to Treat Postinduction Hypotension in High-Risk Non-Cardiac Surgery Patients - The Multicenter INDUCT Trial (INDUCT-Multi)
This trial will test whether giving norepinephrine as a continuous infusion instead of repeated boluses during induction of general anesthesia reduces low blood pressure in high-risk non-cardiac surgery patients.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 446 (estimated) |
| Ages | 45 Years and up |
| Sex | All |
| Sponsor | Universitätsklinikum Hamburg-Eppendorf Academic / other |
| Locations | 4 sites (Düsseldorf and 3 other locations) |
| Trial ID | NCT07538388 on ClinicalTrials.gov |
What this trial studies
INDUCT-Multi is a multicenter, randomized comparison of continuous norepinephrine infusion versus repeated bolus dosing started during induction of general anesthesia. The trial enrolls consenting patients aged 45 and older having elective major non-cardiac surgery who will have radial arterial catheter monitoring and carry predefined risk factors for acute kidney injury. Continuous arterial blood pressure monitoring is used during induction and the assigned norepinephrine strategy is applied to maintain blood pressure. The main focus is on reducing the frequency and severity of postinduction hypotension, with secondary interest in downstream organ injury such as acute kidney injury and overall hemodynamic stability.
Who should consider this trial
Good fit: Ideal candidates are consenting adults (≥45 years) scheduled for elective major non-cardiac surgery with planned continuous radial arterial blood pressure monitoring and at least two specified risk factors for perioperative acute kidney injury.
Not a fit: Patients unlikely to benefit include those with a clinical indication for continuous norepinephrine already, active cardiac arrhythmias, pregnancy, certain intracranial conditions, or those unable to consent in German or who will not have arterial line monitoring.
Why it matters
Potential benefit: If successful, this approach could produce more stable blood pressure during induction and reduce episodes of severe hypotension and related complications such as acute kidney injury.
How similar studies have performed: A prior single-center randomized trial showed improved blood pressure stability with continuous norepinephrine, but multicenter confirmation is limited and this trial seeks broader validation.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: We will include consenting patients ≥45 years scheduled for elective major non-cardiac surgery under general anesthesia with planned continuous intra-arterial blood pressure monitoring with a radial arterial catheter and with at least two of the following risk criteria for developing acute kidney injury: * Age ≥65 years * ASA physical status III or IV * Chronic arterial hypertension * Diabetes mellitus requiring medication * Intra-abdominal surgery * Preoperative renal insufficiency (serum creatinine ≥1.2 mg/dL) Exclusion Criteria: * Pregnancy * Cardiac arrhythmia * History of intracranial hemorrhage or intracranial aneurysm * Clinical indication for continuous norepinephrine infusion during induction of general anesthesia (e.g., severe aortic valve stenosis, coronary artery disease, or heart failure) * Patients who are unable to understand, read, and provide informed consent in German
Where this trial is running
Düsseldorf and 3 other locations
- Department of Anesthesiology, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf — Düsseldorf, Germany (Not_yet_recruiting)
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen — Giessen, Germany (Not_yet_recruiting)
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf — Hamburg, Germany (Not_yet_recruiting)
- Department of Anaesthesiology, University Hospital LMU Munich — München, Germany (Recruiting)
Study contacts
- Study coordinator: Kristen K Thomsen, MD
- Email: kr.thomsen@uke.de
- Phone: +4940741070215
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.