Peri-operative midodrine:

 

Rationale:

Hypotension is bad

     ↑AMI and MINS

     ↑Stroke

     ↑AKI

     ↑Delirium

     ↑Falls

     ↑Death

 

mAP <55mmHg even once is bad

Hypotension is common

     Up to 25% are hypotensive for 30 mins

     Mostly unnoticed

Horses for courses

     Hypovolaemia: Rx fluid

     Vasoplegia: Rx vasopressor

 

Pros and cons:

Benefits

Patient:

     ↓Complications of hypotension

     ↓Complications of excess IV fluid

     ↓Complications of CVC insertion

 

Hospital:

     ↓ICU stay

     ↓PACU stay

     ↓MET call

     ↓Morbidity

     ↓Mortality

Risks

      Prevent identification of bleeding

      Supine severe hypertension

      Urinary retention

Contraindications

      Unable to absorb (e.g. bowel obstruction)

      Alpha agonist unsafe (e.g. severe PVD)

 

Use:

Dose

     5-15mg

Frequency

     Q4h

     Reduced in renal impairment

Max daily

     60mg

 

Causes of peri-op hypotension:

Anaesthesia

      General anaesthesia

      Opioids

      Neuraxial anaesthesia

Surgery

      Fasting

      Inflammation

      Bleeding

      Third spacing

Patient

      Heart problems

      Autonomic nervous system problems

      Anti-hypertensives

      Negative chronotropes and negative inotropes

 

 

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