Preemptive noradrenaline infusion: a game-changer against post-induction hypotension in surgical sepsis: a randomized double blind trial

Abstract Background Post-induction hypotension is a frequent and clinically significant complication in patients with sepsis undergoing source control surgery, often leading to adverse outcomes such as acute kidney injury. Despite its prevalence, targeted strategies to prevent post-induction hypotension in this population remain underexplored. We aimed to evaluate the efficacy of prophylactic noradrenaline infusion (0.2 µg/kg/min) in reducing the incidence of post-induction hypotension in patients with surgical sepsis. Methods In this randomized controlled trial, 80 adult patients with surgical sepsis were allocated to receive either noradrenaline infusion or saline placebo before anesthesia induction. Baseline demographics, laboratory values, and intraoperative parameters were also recorded. The primary outcome was the incidence of postinduction hypotension, defined as a > 20% reduction in mean arterial pressure within 10 min of induction. The secondary outcomes included the time to the first hypotensive episode, ephedrine requirements, incidence of acute kidney injury, and other postoperative complications. Results The baseline characteristics were comparable between the groups. The noradrenaline group demonstrated a significantly lower incidence of post-induction hypotension (10% vs. 45%, p < 0.001). Moreover, the incidence of acute kidney injury was markedly lower in the noradrenaline-treated cohort (5%) than in the saline-control group (23%). In contrast, no statistically significant differences were observed between the groups with respect to other clinical outcomes, including myocardial infarction, renal replacement therapy, stroke, and delirium. Conclusion Prophylactic noradrenaline infusion before anesthesia induction significantly improves hemodynamic stability and reduces the risk of acute kidney injury in patients with sepsis undergoing source control surgery. These findings support the use of this technique as a safe and effective strategy for preventing post-induction hypotension in high-risk surgical populations. Trial registration The clinical study was registered on ClinicalTrials.gov by the principal investigator, M. Helmy, under the identifier NCT07022730 on June 7, 2025.