Of size and men. A call for larger trials and meta-analyses on vasopressors during general anesthesia

Hypotension represents a common clinical challenge, typi-cally managed by fluid administration, including blood transfu-sion (eg, in case of dehydration or hemorrhage), inotropes (eg,dobutamine), vasopressors (eg, epinephrine), cardiac chrono-tropic stimulation (eg, with atropine or pacing for bradycardia),and mechanical cardiopulmonary support (eg, extracorporealmembrane oxygenation. Although many different agents areavailable for vasopressor purposes (eg, angiotensin II, argipressin,dopamine, dopexamine, ephedrine, epinephrine, norepinephrine,phenylephrine, pituitrin, selepressin, terlipressin, and vaso-pressin), such a plethora of alternatives constitutes a verita-ble challenge and area of persistent uncertainty. larger and more numerous trials direly areneeded to better inform clinical decision-making for patientsundergoing general anesthesia with hypotension or shock.Meanwhile, equipoise between norepinephrine and vasopres-sin still holds, at least for surrogate hemodynamic endpointssuch as mean blood pressure, heart rate, central venous pres-sure, cardiac output, and cardiac index