{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:02:19Z","timestamp":1784538139942,"version":"3.55.0"},"reference-count":64,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: Intraoperative hypotension (IOHs) affects up to 87% of patients under general anesthesia and is consistently associated with acute kidney injury, myocardial damage, stroke, and mortality. The intermittent unavailability of ephedrine across healthcare systems underscores the need for evidence-based alternatives. This review critically evaluates pharmacological options for IOH when ephedrine is unavailable, focusing on receptor pharmacodynamics, population-specific evidence, and clinical consequences of inadequately managed hypotension. Methods: A narrative, evidence-based review was conducted examining mechanisms of action, dosing strategies, adverse effect profiles, and clinical applicability of key vasoactive agents: ephedrine, phenylephrine, norepinephrine, and epinephrine. Population-specific evidence across obstetric, pediatric, and elderly cohorts was synthesized from randomized controlled trials, meta-analyses, and observational studies. The clinical impact of IOH on neurological, cardiovascular, and renal outcomes was reviewed. Results: Each vasopressor exhibits a distinct receptor-selectivity profile that determines its hemodynamic effect and optimal clinical context. Norepinephrine\u2019s favorable \u03b11\/\u03b21 balance tends to preserve cardiac output better than pure \u03b11-agonists and has emerged as a promising alternative in obstetric and elderly populations, although the optimal agent ultimately depends on the underlying mechanism of hypotension and individual patient characteristics. Epinephrine provides combined vasopressor and inotropic support for hypotension with myocardial depression. IOH is associated with a greater than twofold increase in postoperative AKI and significantly elevated risks of myocardial infarction and stroke, with outcomes driven by cumulative hypotensive exposure rather than isolated pressure nadirs. Conclusions: Effective management of IOH requires individualized vasopressor selection guided by underlying pathophysiology, cardiovascular profile, and surgical context. A physiology-based strategy\u2014rather than protocol-driven drug substitution\u2014enables anesthesiologists to achieve precise hemodynamic control and preserve end-organ perfusion even when ephedrine is unavailable.<\/jats:p>","DOI":"10.3390\/jpm16070384","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:09:09Z","timestamp":1784527749000},"page":"384","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmacologic Strategies for Intraoperative Hypotension When Ephedrine Is Unavailable: An Evidence-Based Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Gilberto","family":"Duarte-Medrano","sequence":"first","affiliation":[{"name":"Department of Anesthesia, Hospital Medica Sur, Mexico Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City 14050, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Nu\u00f1o-L\u00e1mbarri","sequence":"additional","affiliation":[{"name":"Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City 14050, Mexico"},{"name":"Department of Surgery, Faculty of Medicine, The National Autonomous University of Mexico (UNAM), Escolar 411A, Copilco Universidad, Coyoac\u00e1n, Mexico City 04510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2672-541X","authenticated-orcid":false,"given":"Diana","family":"Chavez-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Hospital Medica Sur, Mexico Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City 14050, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4602-5081","authenticated-orcid":false,"given":"Rebeca Garazi","family":"Elguezabal Rodelo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Hospital Medica Sur, Mexico Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City 14050, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavio","family":"Gonzalez-Chon","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Hospital Medica Sur, Mexico Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City 14050, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-7554","authenticated-orcid":false,"given":"Luigi","family":"La Via","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care 1, University Hospital Policlinico \u201cG. Rodolico\u2013San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref_1","first-page":"942","article-title":"Hypotension prediction index for minimising intraoperative hypotension: A systematic review and meta-analysis of randomised controlled trials","volume":"68","author":"Sriganesh","year":"2024","journal-title":"Indian J. Anaesth."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.21037\/jeccm.2019.10.12","article-title":"Perioperative hypotension: Clinical impact, diagnosis, and therapeutic approaches","volume":"4","author":"Hoppe","year":"2020","journal-title":"J. Emerg. Crit. Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s44158-022-00045-8","article-title":"Perioperative hypotension: Causes and remedies","volume":"2","author":"Guarracino","year":"2022","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Zhao, X., Zhang, Y., Kou, M., Wang, Z., He, Q., Wen, Z., Chen, J., Song, Y., Wu, S., and Huang, C. (2024). The exploration of perioperative hypotension subtypes: A prospective, single cohort, observational pilot study. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1358067"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Weinberg, L., Li, S.Y., Louis, M., Karp, J., Poci, N., Carp, B.S., Miles, L.F., Tully, P., Hahn, R., and Karalapillai, D. (2022). Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: A review. BMC Anesth., 22.","DOI":"10.1186\/s12871-022-01605-9"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.bja.2019.01.013","article-title":"Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery","volume":"122","author":"Sessler","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.bja.2023.05.027","article-title":"Intraoperative arterial pressure management: Knowns and unknowns","volume":"131","author":"Karamchandani","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jointm.2023.06.001","article-title":"Expert consensus on blood pressure management in critically ill patients","volume":"3","author":"Yu","year":"2023","journal-title":"J. Intensive Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.ando.2020.03.012","article-title":"Adrenergic receptors and cardiovascular effects of catecholamines","volume":"82","author":"Motiejunaite","year":"2021","journal-title":"Ann. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S0163-7258(00)00092-9","article-title":"\u03b11-adrenergic receptor regulation: Basic science and clinical implications","volume":"88","author":"Michelotti","year":"2000","journal-title":"Pharmacol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.tcm.2005.11.002","article-title":"\u03b2(1)-Adrenergic receptor function, autoimmunity, and pathogenesis of dilated cardiomyopathy","volume":"16","author":"Jahns","year":"2006","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S197","DOI":"10.1164\/ajrccm.161.supplement_2.a1q4-10","article-title":"\u03b2(2)-adrenergic receptor pharmacogenetics","volume":"161","author":"Liggett","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1186\/cc2337","article-title":"Science review: Vasopressin and the cardiovascular system part 1\u2013receptor physiology","volume":"7","author":"Holmes","year":"2003","journal-title":"Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2344\/0003-3006-59.4.159","article-title":"Basic and clinical pharmacology of autonomic drugs","volume":"59","author":"Becker","year":"2012","journal-title":"Anesth. Prog."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/ALN.0b013e3181b160a3","article-title":"Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery","volume":"111","author":"Khaw","year":"2009","journal-title":"Anesthesiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1111\/j.1365-2125.2003.02062.x","article-title":"Modelling the cardiovascular effects of ephedrine","volume":"57","author":"Persky","year":"2004","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/j.1365-2125.2005.02254.x","article-title":"Mechanistic pharmacokinetic modelling of ephedrine, norephedrine and caffeine in healthy subjects","volume":"59","author":"Csajka","year":"2005","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s00380-013-0455-6","article-title":"Ventricular arrhythmias induced by long-term use of ephedrine in two competitive athletes","volume":"30","author":"Casella","year":"2015","journal-title":"Heart Vessels"},{"key":"ref_19","unstructured":"Richards, E., Lopez, M.J., and Maani, C.V. (2026). Phenylephrine. StatPearls, StatPearls Publishing."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Shiraishi, T., Sato, M., Takagi, R., Shigemi, K., and Matsuki, Y. (2026). Effects of Phenylephrine Administration on the Circulatory Dynamics of Patients with Hypotension Due to Bleeding During Surgery, Specifically Left Ventricular End-Diastolic Volume, Effective Arterial Elastance, and Left Ventricular End-Systolic Elastance. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020905"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1007\/s10877-018-0126-3","article-title":"Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension","volume":"32","author":"Kalmar","year":"2018","journal-title":"J. Clin. Monit. Comput."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"34","DOI":"10.11124\/JBISRIR-D-19-00352","article-title":"Effect of phenylephrine on cerebral oxygen saturation and cardiac output in adults when used to treat intraoperative hypotension: A systematic review","volume":"19","author":"Larson","year":"2021","journal-title":"JBI Evid. Synth."},{"key":"ref_23","first-page":"e102074","article-title":"A Randomized Evaluation of Prophylactic Phenylephrine and Left Uterine Displacement for the Reduction of Hypotension After Spinal Anesthesia in Cesarean Delivery","volume":"18","author":"Begum","year":"2026","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"149","DOI":"10.34172\/aim.33931","article-title":"Comparison of the Effects of Norepinephrine and Phenylephrine Infusion in Preventing Hypotension during Spinal Anesthesia for Cesarean Delivery: A Randomized, Double-Blind Clinical Trial","volume":"28","author":"Jalili","year":"2025","journal-title":"Arch. Iran. Med."},{"key":"ref_25","first-page":"e42713","article-title":"Comparing the Effect of Phenylephrine Bolus and Phenylephrine Infusion for Maintaining Arterial Blood Pressure During Cesarean Delivery Under Spinal Anesthesia: A Randomized Prospective Study","volume":"15","author":"Singh","year":"2023","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s00228-015-1876-1","article-title":"Potential cardiovascular adverse events when phenylephrine is combined with paracetamol: Simulation and narrative review","volume":"71","author":"Atkinson","year":"2015","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1111\/anae.16313","article-title":"Noradrenaline-induced changes in cerebral blood flow in health, traumatic brain injury and critical illness: A systematic review with meta-analysis","volume":"79","author":"Meng","year":"2024","journal-title":"Anaesthesia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.2146\/ajhp110001","article-title":"Standardizing i.v. infusion concentrations: National survey results","volume":"68","author":"Phillips","year":"2011","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_29","unstructured":"Smith, M.D., and Maani, C.V. (2026). Norepinephrine. StatPearls, StatPearls Publishing."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/s13049-025-01480-6","article-title":"The effects of norepinephrine in shockable cardiac arrest, a scoping review","volume":"33","author":"Bouman","year":"2025","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1097\/ALN.0000000000005704","article-title":"Early Use of Norepinephrine in High-risk Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial","volume":"143","author":"Flet","year":"2025","journal-title":"Anesthesiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1213\/ANE.0000000000005811","article-title":"Low-Concentration Norepinephrine Infusion for Major Surgery: A Safety and Feasibility Pilot Randomized Controlled Trial","volume":"134","author":"Aykanat","year":"2022","journal-title":"Anesth. Analg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1213\/ANE.0000000000007231","article-title":"Optimal Infusion Rate of Norepinephrine for Prevention of Spinal Hypotension for Cesarean Delivery: A Randomized Controlled Trial, Using Up-Down Sequential Allocation","volume":"141","author":"Khatoon","year":"2025","journal-title":"Anesth. Analg."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Andrei, S., Nguyen, M., Abou-Arab, O., Bouhemad, B., and Guinot, P.G. (2022). Arterial Hypotension Following Norepinephrine Decrease in Septic Shock Patients Is Not Related to Preload Dependence: A Prospective, Observational Cohort Study. Front. Med., 9.","DOI":"10.3389\/fmed.2022.818386"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1093\/postmj\/qgaf234","article-title":"Intravenous adrenaline (epinephrine): Its use in the critical care setting","volume":"102","author":"Bright","year":"2026","journal-title":"Postgrad. Med. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1080\/10903127.2019.1588443","article-title":"Push Dose Epinephrine Use in the Management of Hypotension During Critical Care Transport","volume":"24","author":"Nawrocki","year":"2020","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/PCC.0000000000001448","article-title":"Low-Dose Epinephrine Boluses for Acute Hypotension in the PICU","volume":"19","author":"Reiter","year":"2018","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ajem.2021.07.006","article-title":"Efficacy of bolus-dose epinephrine to manage hypotension in the prehospital setting","volume":"50","author":"Weant","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_39","first-page":"101204","article-title":"The use of epinephrine infusion for the prevention of spinal hypotension during Caesarean delivery: A randomized controlled dose-finding trial","volume":"42","author":"Hasanin","year":"2023","journal-title":"Anaesth. Crit. Care Pain. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e232654","DOI":"10.1136\/bcr-2019-232654","article-title":"Intravenous epinephrine overdose in prehospital management of suspected anaphylaxis","volume":"13","author":"Callum","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Bein, B., Christ, T., and Eberhart, L.H. (2017). Cafedrine\/Theodrenaline (20:1) Is an Established Alternative for the Management of Arterial Hypotension in Germany-a Review Based on a Systematic Literature Search. Front. Pharmacol., 8.","DOI":"10.3389\/fphar.2017.00068"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1007\/s00101-011-1931-y","article-title":"Anesthesiological management of Caesarean sections: Nationwide survey in Germany","volume":"60","author":"Marcus","year":"2011","journal-title":"Anaesthesist"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e062512","DOI":"10.1136\/bmjopen-2022-062512","article-title":"Phenylephrine versus cafedrine\/theodrenaline (Akrinor) for the treatment of spinal anaesthesia-induced maternal hypotension during caesarean section: A retrospective single-centre cohort study","volume":"12","author":"Porsche","year":"2022","journal-title":"BMJ Open"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"R154","DOI":"10.1186\/cc11469","article-title":"Vasopressin and terlipressin in adult vasodilatory shock: A systematic review and meta-analysis of nine randomized controlled trials","volume":"16","author":"Nassar","year":"2012","journal-title":"Crit. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/ALN.0000000000001434","article-title":"Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial","volume":"126","author":"Hajjar","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_46","first-page":"1577","article-title":"Outcomes of Vasopressin-Receptor Agonists Versus Norepinephrine in Adults with Perioperative Hypotension: A Systematic Review","volume":"38","author":"Heybati","year":"2024","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.bja.2019.01.014","article-title":"Effects of vasopressin during a pulmonary hypertensive crisis induced by acute hypoxia in a rat model of pulmonary hypertension","volume":"122","author":"Sugawara","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1093\/bja\/aem180","article-title":"Use of vasopressin after Caesarean section in idiopathic pulmonary arterial hypertension","volume":"99","author":"Price","year":"2007","journal-title":"Br. J. Anaesth."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.bjae.2022.09.002","article-title":"Pulmonary arterial hypertension in pregnancy","volume":"23","author":"Kariyawasam","year":"2023","journal-title":"BJA Educ."},{"key":"ref_50","first-page":"e27166","article-title":"A Prospective Randomized Study Comparing the Bolus Doses of Norepinephrine and Phenylephrine for the Treatment of Spinal Induced Hypotension in Cesarean Section","volume":"14","author":"Tiwari","year":"2022","journal-title":"Cureus"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e18311","DOI":"10.1097\/MD.0000000000018311","article-title":"A randomized double-blind study comparing prophylactic norepinephrine and ephedrine infusion for preventing maternal spinal hypotension during elective cesarean section under spinal anesthesia: A CONSORT-compliant article","volume":"98","author":"Xu","year":"2019","journal-title":"Medicine"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.12659\/MSM.914143","article-title":"A Comparative Study of Bolus Norepinephrine, Phenylephrine, and Ephedrine for the Treatment of Maternal Hypotension in Parturients with Preeclampsia During Cesarean Delivery Under Spinal Anesthesia","volume":"25","author":"Wang","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"491","DOI":"10.4103\/joacp.joacp_189_23","article-title":"Minimum effective dose of intrathecal hyperbaric bupivacaine for cesarean section with and without prophylactic norepinephrine infusion: Randomized triple-blinded trial","volume":"40","author":"Tyagi","year":"2024","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_54","first-page":"101503","article-title":"Use of norepinephrine for intraoperative hypotension in pediatric anesthesia: A French survey","volume":"44","author":"Milhiet","year":"2025","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.bja.2023.02.007","article-title":"Ephedrine to treat intraoperative hypotension in infants: What is the target?","volume":"130","author":"Frykholm","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"21009","DOI":"10.1038\/s41598-023-48178-2","article-title":"Norepinephrine prevents hypotension in older patients under spinal anesthesia with intravenous propofol sedation: A randomized controlled trial","volume":"13","author":"Kim","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"167","DOI":"10.4103\/2277-9175.190943","article-title":"Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery","volume":"5","author":"Abbasivash","year":"2016","journal-title":"Adv. Biomed. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/anae.15535","article-title":"Treatment threshold for intra-operative hypotension in clinical practice-a prospective cohort study in older patients in the UK","volume":"77","author":"Wickham","year":"2022","journal-title":"Anaesthesia"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Liang, T., Yu, J., Li, L., Xie, Y., and Wu, F. (2021). Prophylactic Norepinephrine Infusion Reduces Postoperative Complications and Hospitalization Time in Elderly Patients Undergoing Posterior Lumbar Spinal Fusion. BioMed Res. Int., 2021.","DOI":"10.1155\/2021\/2161036"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1097\/ACO.0000000000000904","article-title":"Intraoperative hypotension and neurological outcomes","volume":"33","author":"Yu","year":"2020","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1053\/j.jvca.2020.11.005","article-title":"Association Between Intraoperative Hypotension and Postoperative Adverse Outcomes in Patients Undergoing Vascular Surgery\u2014A Retrospective Observational Study","volume":"35","author":"Rangasamy","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_62","first-page":"e64579","article-title":"Postoperative Acute Kidney Injury After Intraoperative Hypotension in Major Risk Procedures","volume":"16","author":"Ferreira","year":"2024","journal-title":"Cureus"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e15997","DOI":"10.1016\/j.heliyon.2023.e15997","article-title":"Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis","volume":"9","author":"Cai","year":"2023","journal-title":"Heliyon"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.bja.2023.08.026","article-title":"Intraoperative hypotension and postoperative outcomes: A meta-analysis of randomised trials","volume":"131","author":"Fominskiy","year":"2023","journal-title":"Br. J. Anaesth."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/7\/384\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:06:28Z","timestamp":1784534788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/7\/384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":64,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jpm16070384"],"URL":"https:\/\/doi.org\/10.3390\/jpm16070384","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]}}}