Norepinephrine

Abstract

Compartment syndrome, peripheral vasoconstriction and associated complications: 5 case reportsIn a case series of 5 patients (1 man and 4 women) aged 49-79 years, admitted to a hospital in USA between January 2016 and December 2017, four out of the five patients developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene following administration of norepinephrine for haemodynamic instability or hypotension. The remaining one out of the five patients developed peripheral vasoconstriction and compartment syndrome following extravasation at injection site during administration of norepinephrine for acute hypotension [times to reaction onsets not stated;not all dosages stated].Patient 1: A 49-year-old woman was hospitalised due to septic shock secondary to pneumonia. Following admission, she received IV norepinephrine infusion. Subsequently, she developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene on both of her feet. Consequently, she underwent left below-knee amputation. The right foot was salvaged following a transmetatarsal amputation, hyaluronic acid-based matrix coverage and skin grafting.Patient 2: A 77-year-old man was hospitalised due to septic shock secondary to urinary tract infection. Following admission, he received IV norepinephrine infusion. Subsequently, he developed peripheral vasoconstriction complicated by peripheral ischaemia leading to several foci of dry gangrene on his bilateral distal extremities. Multiple amputations and extensive reconstruction was required.Patient 3: A 79-year-old woman, who had poorly controlled diabetes mellitus, was hospitalised due to septic shock secondary to urinary tract infection. Following admission, she received IV norepinephrine infusion. Subsequently, she developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene on multiple digits of her left hand. She needed partial amputations and reconstruction.Patient 4: A 55-year-old woman, who had coronary artery disease, underwent coronary artery bypass grafting. Postoperatively, she received IV norepinephrine infusion for persistent hypotension. Subsequently, she developed peripheral vasoconstriction complicated by peripheral ischaemia leading to dry gangrene of her right forefoot. Consequently, she underwent transmetatarsal amputation and reconstruction.Patient 5: A 72-year-old woman, who had coronary artery disease, underwent coronary artery bypass grafting. Postoperatively, she received IV norepinephrine 2mL via a peripheral line in the dorsal right hand during an episode of acute hypotension. However, the injection site was infiltrated due to norepinephrine extravasation, resulting in compartment syndrome. As a result, she developed severe hand necrosis. Consequently, she was referred for hand disarticulation with flap reconstruction and prosthesis fitting.