Key result
Low-concentration norepinephrine use increased by 92.4% from 2017 to 2022, though manually prepared dilutions showed median concentration errors up to 13.4% and up to 32% degradation over 24 hours.
Why the study?
The use of low-concentration norepinephrine appears to be increasing, but its current role and associated challenges in managing intra-operative hypotension needed to be better defined.
Observational
Yes
The use of low-concentration norepinephrine is increasing in French operating rooms, but manual dilution inaccuracies and stability issues highlight the need for ready-to-use formulations.
BACKGROUND Traditionally, ephedrine and phenylephrine have been used to maintain blood pressure during anaesthesia. The use of low-concentration norepinephrine (‘baby norepinephrine’, bNOR) appears to be increasing. OBJECTIVES To better define the current role of norepinephrine in the management of intra-operative hypotension and to identify the challenges associated with its use. DESIGN A practice survey (including collection of vasopressor usage data and a questionnaire on the use of bNOR in French operating rooms), combined with pharmacological assessments of norepinephrine dilutions. SETTING Vasopressor usage data were collected between 2017 and 2022 in 21 French hospitals. The survey was conducted from July 2021 to April 2022 among anaesthesia personnel within the French-speaking community. Pharmacological analyses were performed in two French university hospitals. PATIENTS None. INTERVENTION None. MAIN OUTCOME MEASURES To assess vasopressor use in operating theatres in France, and to evaluate the accuracy and stability of manually prepared bNOR dilutions. RESULTS Usage data demonstrated an increase in norepinephrine use from 28 518 to 59 598 vials (+92.4%), whereas phenylephrine use decreased over the same period from 49 407 vials and prefilled syringes to 14 252 (−71.1%). Survey findings indicated that a majority of respondents (72.5%) use bNOR diluted to concentrations of 10 and 16 μg ml −1 . The principal barrier to routine use identified was the risk of dilution inaccuracy. Norepinephrine concentrations were then measured in 16 samples of 10 μg ml −1 and 50 samples of 5 μg ml −1 manually prepared bNOR. Median concentration errors were 10.8% (± 1.34 μg ml −1 ) for 10 μg ml −1 dilutions and 13.4% (± 0.54 μg ml −1 ) for 5 μg ml −1 dilutions. Stability testing revealed a reduction in norepinephrine concentration of up to 32% over 24 h. CONCLUSION bNOR is emerging as a standard approach for the management of intra-operative hypotension in French operating theatres. However, dilution inaccuracies and stability limitations highlight the need for ready-to-use formulations in order to reduce errors and improve peri-operative care.
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Iraqi et al. (2026) conducted an observational in intra-operative hypotension. Low-concentration norepinephrine (bNOR) was evaluated on Vasopressor use trends and accuracy/stability of manually prepared bNOR dilutions. Low-concentration norepinephrine use increased by 92.4% from 2017 to 2022, though manually prepared dilutions showed median concentration errors up to 13.4% and up to 32% degradation over 24 hours.
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