Intraoperative hypotension arises during general anesthesia with an incidence ranging from 5% to 99% (Anesthesiology 2007;107:213-20). Continuous infusions of norepinephrine to treat perioperative hypotension are generally administered through a central venous catheter (CVC) and not through a peripheral I.V. line (PIV). Although commonly used in perioperative anesthesia care in Northern Europe, peripherally administered norepinephrine is uncommon in U.S. anesthetic practice because of the perceived risk of extravasation and resulting tissue injury (Eur J Anaesthesiol 2015;32:571-80; Am Surg 2016;82:162-3).
However, the use of CVCs has been associated with additional costs, significant morbidity, and complications including infection, which has been reported in approximately 15% of patients (Intensive Care Med 2002;28:18-28). Further, the findings for PIVs are mainly on the case report level, and there is limited safety data of when peripheral norepinephrine is used to counteract anesthesia-associated hypotension in elective surgical cases.
Thus, a new...
