Intravenous adrenaline during general anaesthesia: incidence and adverse events over 11 years

Adrenaline is an emergency medication used in critical situations. However data on its early adverse events after intravenous injection are limited. Therefore, the goal of this study is to describe the incidence of adverse events associated with perioperative use of adrenaline. We conducted a retrospective, single-centre study including all adult patients who received intravenous adrenaline during general anaesthesia at Lille University Hospital between January 2012 and December 2023. Patients who received non-intravenous routes, continuous infusions only, or underwent cardiothoracic surgery were excluded. Data on demographics, comorbidities, indications, cumulative adrenaline dose, and adverse outcomes (hypertension, tachycardia, Takotsubo syndrome and intracerebral haemorrhage) were extracted from our data warehouse. Analyses were descriptive, focusing on estimating the incidence of intravenous adrenaline administration and describing adverse event patterns within the exposed cohort. Among 549,089 anaesthetic procedures, adrenaline was administered in 591 eligible cases (incidence: 1.07/1,000). The median cumulative dose was highest in cardiac arrest (5,000 µg; IQR [2,000–10,000], compared with 200 µg [100–1,000] in anaphylaxis and 300 µg [100–1,000] in refractory hypotension. Severe hypertension occurred in 31% of cases, tachycardia in 47%, Takotsubo syndrome in 3%, and intracerebral haemorrhage in 1%. Three-month mortality was 70.3% in cardiac arrest, 30.0% in refractory hypotension, and 3.0% in anaphylaxis. Intravenous adrenaline was used infrequently but was associated with frequent acute haemodynamic adverse events. Mortality varied markedly by indication. These findings highlight the need for cautious titration, close monitoring, and further research to optimise the safe perioperative use of adrenaline.