Early use of norepinephrine in high-risk patients undergoing major abdominal surgery: a randomized controlled trial

When major abdominal surgery pushes patients to the brink, timing is everything, especially with norepinephrine. Could giving it earlier to high-risk patients prevent dangerous drops in blood pressure and reduce complications?

A new randomized controlled trial, published in Anesthesiology (2025), put this to the test, comparing early, low-dose norepinephrine infusion against standard care in high-risk surgical patients. The results may surprise you: early norepinephrine not only stabilized blood pressure faster but also significantly reduced postoperative complications without increasing adverse events.

In this episode, we break down what “early” really means, why the trial’s pragmatic design matters, and how this could reshape perioperative hemodynamic management in major surgery.

Key takeaways:
• Early norepinephrine led to more stable intraoperative blood pressure
• Reduced risk of postoperative complications in high-risk patients
• No significant increase in adverse events compared to standard care

This isn’t just about drugs, it’s about redefining timing in critical surgical care.

Want to dig deeper? Check out the full study:
Trocheris-Fumery O, Flet T, Scetbon C, et al. Early Use of Norepinephrine in High-Risk Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial. Anesthesiology. 2025. doi:10.1097/ALN.0000000000005704