Norepinephrine (Noradrenaline — Perioperative Vasopressor)

How it works

It is a predominantly alpha-1 adrenergic agonist causing vasoconstriction, with some beta-1 activity, raising systemic vascular resistance and mean arterial pressure.

Prescribing in practice

• Extravasation can cause severe local vasoconstriction and tissue necrosis; administer via a secure central line where feasible and monitor the infusion site.
• It must be given as a controlled continuous infusion, ideally with invasive arterial pressure monitoring in a critical care or theatre setting.
• Excessive vasoconstriction can compromise organ and peripheral perfusion despite an adequate blood pressure.

Monitoring

Continuous blood pressure (preferably invasive), heart rate and infusion-site monitoring are required throughout administration.

Counselling the patient

• This is a critical care medicine given by infusion under close monitoring.
• The team will watch the drip site closely for any leakage.

Evidence & guidelines

Norepinephrine is the recommended first-line vasopressor for septic shock in the Surviving Sepsis Campaign guidelines and is widely used for perioperative hypotension.