Evaluating intraoperative norepinephrine versus fresh frozen plasma in patients undergoing cytoreductive surgery and HIPEC to reduce renal insult

Abstract

Objective This study aims to compare the efficacy of intraoperative norepinephrine infusion versus plasma in reducing renal insult during cytoreductive surgeries.Methods Sixty patients (ASA I–III) of both genders were included in the study. Plasma group: received early fresh frozen plasma and RBCs in ratio exceeded 1:1, and norepinephrine group: received continuous low-dose norepinephrine (0.05–0.1 mic/kg/min).Results Both groups were comparable for their clinical characteristics and distribution of demographic data. Plasma group had significant elevation of their intraoperative heart rate with significant reduction in their mean arterial blood pressure values compared to norepinephrine group (30.3 ± 4.1 versus 17.9 ± 4.5 bpm and −21.6 ± 2.2 versus −16.1 ± 2.3 mmHg, respectively, p < 0.001) with preserved urine output (748.3 ± 92.4 for norepinephrine group versus 693.3 ± 117.2 ml for plasma group, p = 0.048) and better renal outcome (0.2 ± 0.1 mg/dl increase in serum creatinine level for norepinephrine group versus 0.3 ± 0.1 mg/dl for plasma group, p < 0.001). Additionally, patients in the norepinephrine group required less intraoperative blood and fresh frozen plasma transfusion (3.1 ± 1.8 units) compared to the plasma group (4.3 ± 1.3 units), p < 0.001.Conclusion Norepinephrine infusion can play a promising role in maintaining hemodynamic stability with adequate tissue perfusion and better renal outcome in patients undergoing CRS/HIPEC procedures.

Keywords

• CRS
• HIPEC
• plasma
• norepinephrine
• renal injury