• Jens Christensen, Elisabeth Andersson, Fredric Sjöberg, Elisabeth Hellgren, Piotr Harbut, Joanna Harbut, Fredrik Sjövall, Christian von Bruhn Gufler, Johan Mårtensson, Rebecka Rubenson Wahlin, Eva Joelsson-Alm, and Maria Cronhjort.
• From the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
• Anesth. Analg. 2024 Jun 1; 138 (6): 124212481242-1248.

BackgroundPerioperative treatment of hypotension by intravenous administration of norepinephrine in a peripheral vein can lead to adverse events, for example, tissue necrosis. However, the incidence and severity of adverse events during perioperative administration are unknown.MethodsThis was a prospective observational study conducted at 3 Swedish hospitals from 2019 to 2022. A total of 1004 patients undergoing surgery, who met the criteria for perioperative peripheral norepinephrine administration, were included. The infusion site was inspected regularly. If swelling or paleness of skin was detected, the infusion site was changed to a different peripheral line. Systolic blood pressure and pulse frequency were monitored during the infusion time and defined as adverse events at >220 mm Hg and <40 beats•min -1 . In case of adverse events, patients were observed for up to 48 hours. The primary outcome was prevalence of extravasation, defined as swelling around the infusion site. Secondary outcomes were all types of adverse events and associations between predefined clinical variables and risk of adverse events.ResultsWe observed 2.3% (95% confidence interval [CI], 1.4%-3.2%) extravasation of infusion and 0.9% (95% CI, 0.4%-1.7%) bradycardia. No cases of tissue necrosis or severe hypertension were detected. All adverse events had dissipated spontaneously within 48 hours. Proximal catheter placement was associated with more adverse events.ConclusionsExtravasation of peripherally administrated norepinephrine in the perioperative period occurred at similar rates as in previous studies in critically ill patients. In our setting, where we regularly inspected the infusion site and shifted site in case of swelling or paleness of skin, we observed no case of severe adverse events. Given that severe adverse events were absent, the potential benefit of this preventive approach requires confirmation in a larger population.Copyright © 2024 International Anesthesia Research Society.

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