Scoping Review: Is Push-Dose Norepinephrine a Better Choice?

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pharmacology

Background:

• Push-dose vasopressors are commonly used to manage anesthesia-induced hypotension.
• Norepinephrine is increasingly considered as an alternative to phenylephrine and epinephrine.
• Evidence for push-dose norepinephrine in emergency and critical care is limited.

Purpose of the Study:

• To evaluate the clinical use and evidence surrounding push-dose norepinephrine.
• To compare the efficacy and safety of push-dose norepinephrine with other vasopressors.
• To identify research gaps in the emergency and critical care settings.

Main Methods:

• A scoping review of publications on push-dose norepinephrine in human subjects.
• Searched PubMed and Google Scholar for relevant research studies.
• Included randomized controlled trials comparing norepinephrine to phenylephrine, ephedrine, and epinephrine.

Main Results:

• A majority of studies focused on spinal anesthesia for cesarean sections; fewer addressed general anesthesia.
• Limited literature exists for emergency and critical care applications.
• Norepinephrine was demonstrated to be safe and effective in 27 reviewed studies, including 17 randomized controlled trials.

Conclusions:

• Push-dose norepinephrine shows safety and efficacy, with favorable hemodynamic markers compared to other agents.
• Clinical benefits include ease of administration and reduced need for repeat doses.
• Further high-quality research in emergency and critical care is recommended to confirm findings.