Peri-operative midodrine:

 

Rationale:

Hypotension is bad

·      ↑AMI and MINS

·      ↑Stroke

·      ↑AKI

·      ↑Delirium

·      ↑Falls

·      ↑Death

 

mAP <55mmHg even once is bad

mAP <80mmHg for 10 minutes 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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