Uemura et al.

BMC Anesthesiology (2023) 23:283 BMC Anesthesiology

https://doi.org/10.1186/s12871-023-02244-4

RESEARCH Open Access

Hemodynamic impact of ephedrine

on hypotension during general anesthesia:
a prospective cohort study on middle-aged
and older patients
Yuta Uemura1,2, Michiko Kinoshita2*, Yoko Sakai3 and Katsuya Tanaka1,2

Abstract
Background Ephedrine is a mixed α- and β-agonist vasopressor that is frequently used for the correction of hypoten-
sion during general anesthesia. β-responsiveness has been shown to decrease with age; therefore, this study aimed
to determine whether aging would reduce the pressor effect of ephedrine on hypotension during general anesthesia.
Methods Seventy-five patients aged ≥ 45 years were included in this study, with 25 patients allocated to each
of the three age groups: 45–64 years, 65–74 years, and ≥ 75 years. All patients received propofol, remifentanil,
and rocuronium for the induction of general anesthesia, followed by desflurane and remifentanil. Cardiac output (CO)
was estimated using esCCO technology. Ephedrine (0.1 mg/kg) was administered for the correction of hypotension.
The primary and secondary outcome measures were changes in the mean arterial pressure (MAP) and CO, respec-
tively, at 5 min after the administration of ephedrine.
Results The administration of ephedrine significantly increased MAP (p < 0.001, mean difference: 8.34 [95% con-
fidence interval (CI), 5.95–10.75] mmHg) and CO (p < 0.001, mean difference: 7.43 [95% CI, 5.20–9.65] %) across all
groups. However, analysis of variance revealed that the degree of elevation of MAP (F [2, 72] = 0.546, p = 0.581,
η2 = 0.015 [95% CI, 0.000–0.089]) and CO (F [2, 72] = 2.023, p = 0.140, η2 = 0.053 [95% CI, 0.000–0.162]) did not differ
significantly among the groups. Similarly, Spearman’s rank correlation and multiple regression analysis revealed no sig-
nificant relation between age and the changes in MAP or CO after the administration of ephedrine.
Conclusion The administration of ephedrine significantly increased MAP and CO; however, no significant correlation
with age was observed in patients aged > 45 years. These findings suggest that ephedrine is effective for the correc-
tion of hypotension during general anesthesia, even in elderly patients.
Trial registration UMIN-CTR (UMIN000045038; 02/08/2021).
Keywords Aging, Elderly, Ephedrine, Hemodynamics, Hypotension

*Correspondence:
Michiko Kinoshita
michiko-kinoshita@tokushima-u.ac.jp
Full list of author information is available at the end of the article

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Uemura et al. BMC Anesthesiology (2023) 23:283 Page 2 of 9

Background Patient recruitment

Hypotension is common during general anesthesia and This single-center study was conducted at the Tokushima
is associated with postoperative mortality and morbid- University Hospital between July and November 2021.
ity [1–3]. Even a short period of intraoperative hypo- Seventy-five patients aged ≥ 45 years were included in
tension is associated with acute kidney injury and this study, with 25 patients allocated to each of the fol-
cardiovascular events [4, 5]. Vulnerability to hemo- lowing three age groups: middle age group, 45–64 years
dynamic disturbances increases with age; therefore, of age; early elderly group, 65–74 years of age; and late
fast-acting treatments must be administered to elderly elderly group, ≥ 75 years of age. Only patients aged ≥ 45
patients who develop hypotension during anesthesia [6, years were included in this study as distinct patient pro-
7]. files were anticipated between the younger and middle-
Ephedrine, a mixed α-adrenergic and β-adrenergic aged to older age groups. Consecutive patients who
receptor agonist, is frequently used for the correction received ephedrine during the observation period start-
of hypotension during general anesthesia [8, 9]. Previ- ing from the earliest date of surgery were included until
ous studies have reported that ephedrine maintains or the sample size reached 25 patients in each group.
increases the cardiac output (CO) by stimulating the The eligibility criteria were as follows: ≥45 years of age;
β-adrenergic receptor, which may improve tissue per- American Society of Anesthesiologists Physical Status
fusion and oxygenation [10–12]. Thus, ephedrine is I or II; and scheduled to undergo surgery under general
expected to have a more favorable profile than pure anesthesia. All potentially eligible patients were evaluated
α-agonists, such as phenylephrine, for the treatment in advance at the outpatient anesthesiology department.
of hypotension [13]. However, elderly patients may The exclusion criteria were as follows: surgery performed
derive fewer benefits from ephedrine [14] as preclini- in a position other than the supine position; the presence
cal studies have indicated that potential factors related of cardiovascular, respiratory, or severe mental disease;
to advanced age may result in a reduced hemodynamic the presence of neurological disorder or severe liver dys-
response to β-agonists [15–17]. No clinical studies have function; electroconvulsive therapy; dialysis; pregnancy;
examined the age-related differences in the hemody- obesity (body mass index [BMI] ≥ 35 kg/m2) or ema-
namic effect of ephedrine. ciation (BMI < 14 kg/m2); and estimated continuous CO
Therefore, this study aimed to determine whether (esCCO; Nihon Kohden, Tokyo, Japan) that was deemed
aging would reduce the pressor effects of ephedrine on difficult to measure. Patients who did not receive ephed-
hypotension during general anesthesia. The primary rine during the observation period were also excluded.
objective of this study was to examine the age-related
differences in the increase in the mean arterial pres-
sure (MAP) after the administration of ephedrine. The General anesthesia, data collection, and outcomes
secondary objective was to evaluate the age-related dif- Patients, except for those scheduled to undergo gastro-

(Arginaid Water®; Nestle Japan, Kobe, Japan) as needed

ferences in the increase in CO after the administration intestinal surgery, received oral rehydration solution
of ephedrine. In addition, the changes in systolic blood
pressure (SBP), diastolic blood pressure (DBP), heart until 2 to 3 h before entering the operating room. Propo-
rate (HR), and stroke volume (SV) were also evaluated fol (0.5–2.0 mg/kg), remifentanil (0.2–0.5 µg/kg/min),
as secondary outcomes. and rocuronium (0.6 mg/kg) were administered for the
induction of general anesthesia, followed by desflurane
(3–5%) and remifentanil (0.05–0.5 µ/kg/min) to maintain
Methods the bispectral index value at 40–60. Endotracheal intuba-
Study design and ethics tion or supraglottic instrument insertion was performed,
This prospective observational cohort study was followed by mechanical ventilation to maintain the end-
approved by the Tokushima University Hospital Ethics tidal ­CO2 levels at 35–45 mmHg. Ringer’s solution ace-
Committee (approval number: 4000; 28/06/2021) and tate (10 mL/kg/h) was administered through a secured
registered with the University Hospital Medical Informa- intravenous line. The pulse wave transit time was meas-
tion Network Clinical Trial Registry (UMIN000045038; ured to estimate CO and SV using esCCO technology.
02/08/2021). All patients provided written informed con- The blood pressure was measured non-invasively with
sent prior to the start of the study. This work adheres to an upper arm cuff every 2.5 min. Ephedrine (0.1 mg/kg)
the Strengthening the Reporting of Observational Studies was administered to patients who presented with hypo-
in Epidemiology (STROBE) statement. The administra- tension. Patients who satisfied any of the following con-
tion of ephedrine was justified only for patients who pre- ditions were considered to have hypotension: SBP < 90
sented with hypotension. mmHg, MAP < 65 mmHg, or a decrease in SBP of at least
Uemura et al. BMC Anesthesiology (2023) 23:283 Page 3 of 9

25% compared with that measured in the outpatient or the sample size was rounded to 75 patients (n = 25 per
inpatient department. The blood pressure measured in age group).
the outpatient department referred to measurements
obtained by the patients themselves at any hour dur- Statistical analysis
ing the daytime using an automatic sphygmomanom- Data are presented as the mean (SD) or number (%).
eter, whereas blood pressure measured in the inpatient Numerical variables were assessed using a one-way or
department referred to the measurements obtained by repeated-measures analysis of variance (ANOVA). Binary
nurses on the morning of the day of the surgery. If the variables were assessed using the chi-square test, and
patient met the hypotension criteria 5 min after the Fisher’s exact test was performed when there were five
administration of ephedrine, phenylephrine (0.002 mg/ or fewer cells. The F-statistic and the effect size (η²) were
kg) was administered to correct hypotension. Further reported for ANOVA, along with the 95% confidence
treatment was provided at the discretion of the anesthe- interval (CI), for both primary and secondary outcomes.
siologist in charge if no increase in the blood pressure Two sensitivity analyses were performed subsequently.
was observed after the administration of phenylephrine. The association between age and the changes in MAP
The observation period ranged from anesthesia induc- and CO was examined using Spearman’s rank correlation
tion until the start of surgery. Figure 1 presents an over- coefficient. The following four factors that could poten-
view of the study protocol. tially affect changes in MAP and CO were examined
The primary outcome measure was the age-related dif- using a multiple regression analysis: age; BMI related
ferences in the change in MAP 5 min after the adminis- to ephedrine dosage; medication for hypertension with
tration of ephedrine. The secondary outcomes were the angiotensin-converting enzyme inhibitors (ACEIs)/angi-
age-related differences in the change in CO 5 min after otensin receptor blockers (ARBs); and the administration
the administration of ephedrine and the changes in SBP, of preoperative oral rehydration solution. Variance infla-
DBP, HR, and SV. tion factors were calculated for each variable to address
the potential issue of multicollinearity, which can pose
problems in multiple regression analysis; none of the fac-
Sample size tors were found to exceed 5. Statistical significance was
The sample size was calculated by assuming a MAP of set at p < 0.05 (two-sided). Statistical analyses were per-
80 mmHg (standard deviation [SD], 10 mmHg) after the formed using R version 4.1.3 (The R Foundation for Sta-
administration of ephedrine, as described previously [8, tistical Computing) with EZR (Saitama Medical Center,
10]. A 10% difference in hemodynamics was considered Jichi Medical University, Saitama, Japan) [19].
a significant clinical change [10, 12]. Therefore, we aimed
to detect a clinically important difference of 0.8 SD in the Results
primary outcome measure. The effect size (d) of 0.8 was Among the 222 patients initially assessed for eligibil-
converted to an effect size (f ) of 0.4 using the esc package ity, 124 patients were excluded after the application of
in R version 4.1.3 (The R Foundation for Statistical Com- the aforementioned exclusion criteria or due to refusal
puting, Vienna, Austria). Using an effect size (f ) of 0.4, to participate in the study. Among the remaining 98
α error of 0.05, and power of 0.85, the sample size was patients, 23 patients were excluded as ephedrine was
calculated as 72 using G*Power version 3.1.9.6 (Heinrich- not administered to these patients, they had insufficient
Heine-Universität Düsseldorf, Germany) [18]. However, available data, or their treatment deviated from the

Fig. 1 Study protocol. SBP, systolic blood pressure; MAP, mean arterial pressure
Uemura et al. BMC Anesthesiology (2023) 23:283 Page 4 of 9

Fig. 2 Flow diagram. n, number; ASA PS, American Society of Anesthesiologist Physical Status; BMI, body mass index; esCCO, estimated continuous
cardiac output

protocol. The remaining 75 patients were allocated to with the measurement taken in the outpatient or inpa-
one of the three age groups (middle age, early elderly, tient department.
and late elderly groups) (Fig. 2). Table 1 presents the Table 2 presents the hemodynamic changes in MAP
patient characteristics. The youngest patient was 46 and CO during the observation period. No significant
years old, whereas the oldest patient was 87 years old. differences in MAP were observed among the age groups
Older patients tended to have a higher American Soci- at baseline (F [2, 72] = 0.259; p = 0.773), the time of hypo-
ety of Anesthesiologist Physical Status and required tension (F [2, 72]= 0.818; p = 0.446), and 5 min after the
a lower dosage of propofol and remifentanil for the administration of ephedrine (F [2, 72] = 0.128; p = 0.880).
induction of anesthesia. Similarly, no significant differences in CO were observed
Fourteen, 12, and 12 patients from the middle-aged, among the age groups at the time of hypotension (F [2,
early elderly, and late elderly groups, respectively, were 72] = 0.152; p = 0.860) and 5 min after the administration
found to satisfy the hypotension criterion of SBP < 90 of ephedrine (F [2, 72] = 0.735; p = 0.483). The administra-
mmHg. Most patients who satisfied the SBP-based tion of ephedrine significantly increased MAP (p < 0.001;
hypotension criterion also satisfied the MAP-based mean difference, 8.34 mmHg; 95% CI, 5.95–10.75 mmHg)
hypotension criterion. Thus, including duplicates, and CO (p < 0.001; mean difference, 7.43%; 95% CI, 5.20–
eight, 10, and eight patients from the middle-aged, 9.65%) in all groups. However, the increases in MAP (F
early elderly, and late elderly groups, respectively, were [2, 72] = 0.546; p = 0.581; η2 = 0.015; 95% CI, 0.000–0.089)
considered to have satisfied the hypotension criterion and CO (F [2, 72] = 2.023; p = 0.140; η2 = 0.053; 95% CI,
of MAP < 65 mmHg. In addition, 11, 12, and 12 patients 0.000–0.162) did not differ significantly among the age
from the middle-aged, early elderly, and late elderly groups.
groups, respectively, satisfied the hypotension criterion Supplemental Table 1 presents the hemodynamic
of showing a decrease in SBP of at least 25% compared changes in SBP, DBP, HR, and SV. No significant
Uemura et al. BMC Anesthesiology (2023) 23:283 Page 5 of 9

Table 1 Patients’ characteristics

Middle age (45–64 Early elderly (65–74 Late elderly (≥ 75 p values
years) n = 25 years) n = 25 years) n = 25

Age, years 55.6 (5.7) 70.3 (2.6) 79.4 (3.5)

Sex, male/female 7/18 12/13 11/14 0.311
BMI, kg/m2 23.4 (3.6) 22.8 (4.0) 24.0 (2.8) 0.518
ASA PS, I/II 8/17 4/21 1/24 0.036
Use of ACEIs/ARBs 1 4 5 0.319
Anesthetics for induction
Propofol, mg/kg 1.4 (0.2) 1.3 (0.2) 1.1 (0.2) < 0.001
Remifentanil, µg/kg/min 0.32 (0.06) 0.29 (0.04) 0.28 (0.04) 0.016
Anesthetics for maintenance
Desflurane, % 4.0 (0.5) 3.9 (0.5) 3.7 (0.3) 0.078
Remifentanil, µg/kg/min 0.23 (0.05) 0.23 (0.07) 0.20 (0.05) 0.135
Surgery type
Gastrointestinal surgery 3 1 10
Orthopedic surgery 2 1 0
ENT surgery 5 8 1
Ophthalmology surgery 1 2 4
Urologic surgery 2 3 6
Breast surgery 6 6 2
Gynecological surgery 6 4 2
Data are expressed as mean (standard deviation) or number
ACEIs Angiotensin-converting enzyme inhibitors, ARBs Angiotensin receptor blockers, ASA PS American Society of Anesthesiologists Physical Status, BMI Body mass
index, ENT Ear, nose, throat; n number

Table 2 Hemodynamic changes during the observation period among the patient groups
Middle age (45–64 Early elderly (65–74 Late elderly (≥ 75 p values
years) n = 25 years) n = 25 years) n = 25

MAP, mmHg
    Before anesthesia induction (baseline) 107.4 (14.5) 108.6 (9.5) 106.1 (12.6) 0.773
    At the time of hypotension 70.6 (10.6) 67.3 (9.5) 68.5 (7.2) 0.446
    At 5 min after ephedrine administration 78.0 (13.5) 77.5 (15.0) 76.1 (12.3) 0.880
    Change after ephedrine administration 7.3 (9.4) 10.1 (11.0) 7.6 (11.0) 0.581
CO (%)
    Before anesthesia induction (baseline) 100 100 100 1
    At the time of hypotension 74.5 (16.0) 76.3 (15.2) 74.1 (13.8) 0.860
    At 5 min after ephedrine administration 79.5 (15.6) 83.3 (15.6) 84.4 (14.2) 0.483
    Change after ephedrine administration 5.0 (9.2) 7.0 (11.1) 10.3 (8.0) 0.140
Data are expressed as mean (standard deviation)
CO Cardiac output, MAP Mean arterial pressure, n number

differences were observed in SBP, DBP, HR, and SV (p < 0.001; mean difference, 3.49%; 95% CI, 2.48–4.50%)
among the age groups at baseline, the time of hypoten- in all groups. However, the increases in SBP, DBP, HR,
sion, and 5 min after the administration of ephedrine. and SV did not differ significantly among the age groups
The administration of ephedrine significantly increased (p = 0.884, p = 0.348, p = 0.249, p = 0.808, respectively).
SBP (p < 0.001; mean difference, 12.91 mmHg; 95% CI, Spearman’s rank correlation coefficients were not
9.49–16.32 mmHg), DBP (p < 0.001; mean difference, 6.07 statistically significant between age groups and the
mmHg; 95% CI, 3.93–8.21 mmHg), HR (p = 0.002; mean changes in MAP (r = 0.056; p = 0.633) and CO (r = 0.191;
difference, 3.79 bpm; 95% CI, 1.49–6.09 bpm), and SV p = 0.100) (Fig. 3). Multiple regression analysis revealed
Uemura et al. BMC Anesthesiology (2023) 23:283 Page 6 of 9

Fig. 3 Spearman’s rank correlation coefficients for age and the changes in MAP (a) and CO (b). Correlations between age and the changes in MAP
(correlation coefficient, 0.056; p = 0.633) and CO (correlation coefficient, 0.191; p = 0.100). Although the correlation coefficient and p value were
calculated using Spearman’s rank correlation, the linear regression line is presented in this graph. ΔMAP, change in the mean arterial pressure; ΔCO,
change in the cardiac output. MAP, mean arterial pressure; CO, cardiac output

Table 3 Multiple regression analysis of MAP and CO changes hypotensive criterion used in this study despite the
after ephedrine administration administration of ephedrine.
Variables Regression 95% CI p value VIF
coefficient
Discussion
MAP change, mmHg
We examined the hemodynamic responses after the
Age, years 0.050 −0.184 to 0.282 0.680 1.11
administration of ephedrine for the correction of hypo-
BMI, kg/m2 0.653 −0.032 to 1.339 0.062 1.06
tension during general anesthesia among different age
ACEIs/ARBs, binary 5.035 −2.085 to 12.156 0.163 1.03
groups. The administration of ephedrine significantly
Preoperative oral −1.126 −7.382 to 5.130 0.721 1.07
rehydration solution increased MAP and CO; however, there were no signifi-
intake, binary cant age-related differences in these increases among the
CO change, % different age groups. Similarly, no significant differences
Age, years 0.142 −0.070 to 0.353 0.186 1.11 were observed in SBP, DBP, HR, or SV among the differ-
BMI, kg/m2 0.716 0.094 to 1.339 0.025 1.06 ent age groups. The effect sizes (η2) for the changes in
ACEIs/ARBs, binary 0.361 −6.098 to 6.819 0.912 1.03 MAP and CO among the groups were 0.015 and 0.053,
Preoperative oral 3.900 −1.775 to 9.575 0.175 1.07 respectively, and equivalent to the effect sizes (f ) of 0.123
rehydration solution and 0.237, respectively [20, 21]; however, they were con-
intake, binary
siderably smaller than the target of 0.4, which indicated a
ACEIs Angiotensin converting enzyme inhibitors, ARBs Angiotensin receptor clinically important difference, set in this study. Moreo-
blockers, BMI Body mass index, CI Confidence interval, CO Cardiac output,
MAP Mean arterial pressure, VIF Variance inflation factor ver, the sensitivity analyses confirmed that there were no
significant relationships between age and the changes in
MAP and CO after the administration of ephedrine. BMI
no significant relationship between age and the changes was related to the changes in CO after the administra-
in MAP (p = 0.680) and CO (p = 0.186). BMI was sig- tion of ephedrine, possibly because the ephedrine dose
nificantly associated with changes in CO following the was determined based on body weight. Previous studies
administration of ephedrine (p = 0.025). The administra- have shown the dose-dependent effect of ephedrine [22,
tion of ACEIs/ARBs and preoperative rehydration solu- 23]. Preoperative administration of oral rehydration solu-
tions had no significant impact on the hemodynamic tion showed no significant impact on the pressor effect
changes following the administration of ephedrine of ephedrine. This finding is consistent with those of pre-
administration (Table 3). vious reports asserting that preoperative fluid optimiza-
Phenylephrine was administered to 10, 10, and tion via the administration of oral rehydration solution or
seven patients from the middle-aged, early elderly, and infusion loading did not contribute to hemodynamic sta-
late elderly groups, respectively, as they satisfied the bility following the induction of anesthesia [24, 25].
Uemura et al. BMC Anesthesiology (2023) 23:283 Page 7 of 9

Aging is known to impair exercise-induced and phar- administration of ephedrine are maximal at 2 to 3 min
macological stimuli-induced increases in CO [26, 27]. and persist for 5 min [11]. Therefore, the outcomes of
Previous studies have shown that β-adrenergic recep- this study were measured at 5 min after the administra-
tors become desensitized with age; this effect was medi- tion of ephedrine. Second, non-invasive blood pressure
ated by the reduced density of β-adrenergic receptors, measurements were obtained at intervals of 2.5 min.
reduced G-proteins, and impaired β-adrenergic receptor, The continuous measurement of invasive arterial pres-
G-protein, and adenylyl cyclase activity [27]. Although sure would have provided more detailed data; however,
previous studies have indicated that aging may impair the this was deemed inappropriate because of the patients’
physical response to β-adrenergic stimuli, the results of characteristics. Third, only patients aged > 45 years were
the present study suggest that the pressor effect of ephed- included in this study. Younger patients were not exam-
rine during anesthesia does not vary significantly with ined as they are at lower risk of developing hypoten-
age, or at least not to a degree that is clinically signifi- sion during anesthesia and postoperative complications.
cant. Our findings are consistent with those of previous Therefore, this study included middle-aged and elderly
studies that demonstrated that prophylactic ephedrine patients who were deemed to require ephedrine. Fourth,
attenuated circulation suppression after the induction CO was estimated using the esCCO system. The accu-
of anesthesia or subarachnoid anesthesia, even in elderly racy of esCCO is clinically acceptable and comparable
patients [22, 28–30]. To our knowledge, this is the first with that of both thermodilution CO measurements and
study to examine the pressor effect of ephedrine accord- arterial pulse contour-based CO measurements [39–41].
ing to age. As esCCO appears to be better for assessing relative val-
This study could not elucidate the reason for the ues than absolute values, CO was assessed using percent
absence of age-related differences in the pressor effect of changes [40, 41].
ephedrine despite the decrease in β-responsiveness with
age. This finding may be attributed to the following rea-
sons. This study examined patients undergoing surgeries Conclusions
under general anesthesia, and the effects of ephedrine In conclusion, increases in MAP and CO caused by
observed in anesthetized patients may be greater than the administration of ephedrine were not significantly
those observed in non-anesthetized patients [31, 32]. related to age among patients older than 45 years of age.
Propofol and enflurane have been reported to augment These results suggest that ephedrine effectively corrects
pressor responses to ephedrine [31–33], and we used hypotension during general anesthesia, even in elderly
propofol for anesthesia induction in this study. patients.
The main contributor of hypotension during anesthe-
sia induction has been reported to be the decreases in Abbreviations
CO and systemic vascular resistance among elderly and ACEIs Angiotensin converting enzyme inhibitors
ARBs Angiotensin receptor blockers
young patients, respectively [34]. Furthermore, ephed- BMI Body mass index
rine, but not phenylephrine, improves tissue perfusion CO Cardiac output
and oxygenation by maintaining or increasing CO [10– DBP Diastolic blood pressure
esCCO Estimated continuous cardiac output
12]. Thus, our finding that ephedrine may increase CO HR Heart rate
regardless of age has clinically important implications. MAP Mean arterial pressure
Ephedrine acts directly and indirectly on adrenergic SBP Systolic blood pressure
SV Stroke volume
receptors [35, 36]. Its in vivo pressor effects depend pre-
dominantly on indirect actions, specifically, the release of
norepinephrine from the sympathetic nerves [37]. Thus, Supplementary Information
The online version contains supplementary material available at https://​doi.​
the pressor effects of indirect adrenergic agonists such org/​10.​1186/​s12871-​023-​02244-4.
as ephedrine depend on the quantity of norepinephrine
released from the sympathetic nerves, which is altered by Additional file 1: Supplemental Table 1. Hemodynamic changes in the
patient-specific circumstances and medications [38]. patient groups during the observation period.
This study had some limitations. First, the outcomes
were measured 5 min after the administration of ephed- Acknowledgements
rine. A longer observation period would have resulted in We would like to thank Editage (www.​edita​ge.​com) for English language
editing.
a more detailed study. However, previous studies have
reported that even brief hypotension persisting for only Authors’ contributions
5 min is significantly associated with postoperative com- Conceptualization: Yuta Uemura, Michiko Kinoshita, Yoko Sakai, and Katsuya
Tanaka; Methodology: Yuta Uemura, Michiko Kinoshita, Yoko Sakai, and
plications [4]. In addition, circulatory changes after the Katsuya Tanaka; Investigation: Yuta Uemura, Michiko Kinoshita, and Yoko Sakai;
Uemura et al. BMC Anesthesiology (2023) 23:283 Page 8 of 9

Analysis: Yuta Uemura, Michiko Kinoshita, Yoko Sakai, and Katsuya Tanaka; Writ- 8. Xia J, Yuan J, Lu X, Yin N. Prone position results in enhanced pressor
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