- See: -
Inotropic Agents - Discussion: - for hypotension refactory to high doses of
dopamine ( >20 ug/kg/min); - is peripherally converted to
dopamine;
- Dosing: many patients require up to 40 ug/ml - titrate to blood pressure;
- Peds: initially 0.1 ug/kg/min titrated to effect;
- Method of Delivery: - infusion is prepared by diluting 4-8 mg of Norepi in 500ml of D5W (gives 8-16 ug/ml) and infused at an initial rate of 4-12 ug/min;
- Precautions: - central intraarterial monitoring may be required with prolonged infusions to avoid confusion owing to peripheral vasocontriction; - monitor urine output; - infuse into large vein to
avoid extravasation; - if extravasation of norepinephrine occurs, infiltration of subQ tissue w/
phentolamine 5-10 mg in 10-15 ml of NS may prevent tissue necrosis; - must correct blood volume depletion as much as possible prior to initiation of vasopressor therapy; dilute in D5W or D5NS; - interactions w/
MAOIs &
tricyclics leading to severe, prolonged HTN;
