Comparison of Hemodynamic Responses to Administration of Vasopressin and Norepinephrine Under General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis

Objective: The authors performed a meta-analysis to determine if vasopressin improves hypotension more than norepinephrine under general anesthesia. Design: Meta-analysis. Setting: Operating room. Patients: Patients who underwent surgery, with general anesthesia. Interventions: Administration of vasopressin or norepinephrine in order to increase blood pressure. Measurements and Main Results: The primary outcome of this study was to determine if vasopressin increased mean blood pressure more effectively compared with norepinephrine for patients under general anesthesia. The secondary outcome was to see if vasopressin increased heart rate (HR), central venous pressure (CVP), cardiac output (CO), and cardiac index (CI) more significantly compared with norepinephrine under general anesthesia. The authors calculated the weighted mean difference, with 95% confidence interval (CI) using the random-effects model, and calculated the required information size (RIS) by performing trial sequential analysis (TSA). The authors selected 6 studies for analysis. Vasopressin did not improve hypotension compared with norepinephrine under general anesthesia. (weighted mean difference = –0.84 mmHg, 95% CI: –5.90 to 4.23, p = 0.75, Cochran Q = 24.6, I² = 84%) In TSA, only 35.5% of RIS was achieved. Similarly, vasopressin and norepinephrine were not significantly different in terms of HR, CVP, CO, and CI. In TSA, only 23.7% of the RIS was reached for HR but RIS was almost achieved for CVP and CO. Conclusions: Vasopressin did not improve hypotension compared with norepinephrine under general anesthesia. The RIS was not reached in TSA, and Grading of Recommendations Assessment, Development and Evaluation is very low. Therefore, further research is needed to reach more robust conclusions.