Norepinephrine infusion for preventing hypotension during hepatic exteriorization in Kasai portoenterostomy in infants with biliary atresia: A randomized controlled trial

Background: Hepatic exteriorization during Kasai portoenterostomy is usually associated with profound hypotension. This study aimed to assess the role of prophylactic norepinephrine infusion in maintaining blood pressure in infants undergoing Kasai portoenterostomy operation. Methods: Thirty-two infants scheduled for Kasai portoenterostomy operation were randomly assigned to one of two groups: Norepinephrine group: this group received prophylactic intraoperative norepinephrine infusion, Control group: this group received placebo saline infusion. The primary outcome was the incidence of hypotension during liver exteriorization, defined as a persistent reduction of the mean arterial pressure (MAP) >= 20% of the baseline reading requiring release of the liver. Other outcomes included: the frequency of stoppage of surgery and release of the liver, liver function variables, arterial blood gases parameters, total volume of intraoperative infused fluids, and incidence of bradycardia and hypertension. Results: The incidence of persistent hypotension (defined as the need for liver release after administering IV fluid and vasopressor boluses) during liver exteriorization, was 12.5% (2 patients) in the norepinephrine group compared to 75% (12 patients) in the control group, relative risk (95% confidence interval [CI]): 0.17 (0.04-0.63), p = 0.001. Rescue norepinephrine boluses were used in 3 patients (18.8%) in the norepinephrine group compared to 13 patients (81.3%) in the control group, relative risk (95% CI): 0.23 (0.08-0.66), p = 0.001. Conclusion: Among infants with biliary atresia undergoing Kasai portoenterostomy operation, norepinephrine infusion significantly reduced the incidence of persistent severe hypotension during hepatic exteriorization requiring liver release. Clinical trial identifier: NCT05521152. Registration URL: https://clinicaltrials.gov/study/NCT05521152. (c) 2025 Societe Franc,aise d'Anesthesie et de Reanimation (SFAR). Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.