AANA October 2022 Journal Course: The Safety and Efficacy of Peripherally Administered Norepinephrine During the Perioperative Period-Article

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Intraoperative hypotension (IOH) is a common adverse event that occurs during anesthesia induction, and it is associated with negative outcomes and increased mortality. Vasopressor drugs like phenylephrine (PE) and norepinephrine (NE) are commonly used to counteract IOH, with PE historically viewed as the first-line agent. However, recent research suggests that NE may have a more advantageous clinical profile for treating hypotension. NE can maintain or increase cardiac output and restore decreased concentrations of circulating catecholamines. Despite concerns about the safety of peripherally administered NE, recent studies have shown that this stigma may not be justified. Data from human and animal studies suggest that the peripheral administration of NE for the treatment of IOH may not only be acceptable but may be the best option in many cases. Observational studies and retrospective chart reviews have demonstrated low rates of extravasation and no instances of tissue injury with the peripheral administration of NE. Complication rates associated with central line placement can be as high as 22%, highlighting the need to reconsider NE as a first-line agent for hypotension.

Keywords

intraoperative hypotension

IOH

adverse event

anesthesia induction

vasopressor drugs

phenylephrine

norepinephrine

hypotension treatment

complication rates