Use of norepinephrine for intraoperative hypotension in pediatric anesthesia: a French survey

Intraoperative hypotension (IOH) is a common complication in the operating room. Vasopressors are crucial in managing IOH but data on their use in children, particularly norepinephrine (NE), are limited. This study aimed to explore NE use in IOH management among French pediatric anesthesiologists.

A survey was conducted using an online Google Forms® questionnaire, validated by experienced pediatric anesthesiologists and the ADARPEF board. Distributed via the ADARPEF Research Network, the survey covered demographics, IOH definitions, treatment approaches, and NE use.

We received 205 responses (44.1%). IOH was defined as a percent of fall of preoperative arterial pressure for 63.9% of respondents and normogram or age-based formulae value for 33.6%. Cerebral NIRS and invasive arterial blood pressure were the most common tools for monitoring patients with high risk of IOH. For vasoplegia-induced IOH, the first-line treatment was fluid bolus (49.2%) or ephedrine (35.3%). NE was used as second line treatment by 26.2 % of respondents. For IOH due to blood loss, fluid bolus was the primary treatment followed by NE. NE was used monthly by 79.3% of respondents and weekly by 45.3%. Variations in dilution and dosage practices were noted, with 70.5% reporting the use of highly diluted NE. Side effects were reported by 86.1% of NE users.

The survey highlights significant variability to determine the threshold of IOH requiring treatment and vasopressors use. NE is widely used by pediatric anesthesiologists, but practices vary, indicating the need for standardised guidelines and further safety studies.