• 6 mg / 100 mL = 60 mcg/mL
  • or 3 mg / 50 mL syringe
• 1 mL/hr = 1 mcg/min
• Improves tissue perfusion from +INO, so lactate often NOT raised after long case, unlike metaraminol

• 0.1 - 1.0 mcg/kg/min IV

• Titrate to clinical effect

• Bolus 5 mcg IV

  • Roughly 100x potency of metaraminol ~ 500 mcg bolus
  • Roughly 0.1 mcg/kg

• Dilute NAd = Preparation using 1 L bag

  • This is 1/10 concentration of central
  • 1 ampoule 4 mg / 1 L = 4 mcg/mL
  • 0.1 mcg/kg/min - 1 mcg/kg/min
  • 50 kg = 5-50 mcg/min ~ 1-10 mL/hr
  • 100 kg = 10 mcg/min ~ 2-20 mL/hr

• 2 mg / 50 mL

  • Half an ampoule = same concentration as the Agila pumps (4 mg / 100 mL)
  • Allows use of syringe driver
  • 2000 mcg / 50 mL = 40 mcg/mL

• Peripheral NAd

  • No evidence that lower concentrations reduce complications
  • Peripheral use max 6 hours
  • 18 G IVC minimum size
  • Upper limb only
  • Not in ACF / hand
  • Stop if blanching / extravasation
  • Treatment = phentolamine and GTN paste
  • Some recommended concentrations
    • ACI = 60 mcg/mL ~ 6 mg / 100 mL = full strength
      • https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/critical-care
    • BJA 2020
      • No severe complications at 8 mcg/mL = 8000 mcg / 1000 mL = 8 mg / 1 L = 4 mg / 500 mL
        • 1/5 or 20% concentration
      • 32 mcg/mL = 5.5% incidence of microvascular complications
      • Max tested = 82 mcg/mL
      • https://www.bjanaesthesia.org.uk/article/S0007-0912(21)00448-7/fulltext
    • WA Health 2018
      • 4 mg / 500 mL

(molecular structure)

(formulation)

• 4 mg / 4 mL
• prepare with 5% dextrose (⬇oxidation + consequent loss of potency)

Mechanism of action

(molecular effects)

(therapeutic effects + indications / side effects + contraindications)

1:CVS

2:RS

3:NS

4:GIT

5:Renal

6:Endo

7:Reprod

8:Haem

9:MSk

10:Other

• onset = 1-2 minutes
• offset = 5-10 minutes

Absorption

• Bioavailability

Distribution

Metabolism

• main organ of metabolism =
• active metabolites =
• et1/2 = 3 minutes

Excretion

https://www.bettersafercare.vic.gov.au/sites/default/files/2018-12/Noradrenaline_Emergency%20guideline_0.pdf

https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/critical-care

https://www.wacountry.health.wa.gov.au/~/media/WACHS/Documents/About-us/Policies/Peripheral-Vasopressor-Infusion-Guideline---Adults.pdf?thn=0