Abstract
A patient with idiopathic orthostatic hypotension receiving chronic oral midodhne therapy required anaesthesia for coronary artery bypass grafting. A perioperalive infusion ofphenylephrine was substituted for midodrine, an alpha-2 agonist, enabling hypotension resulting from low systemic vascular resistance to be controlled easily. Anticipated adrenergic receptor denervation hypersensitiviry was noted. The only significant perioperative problem was one episode of syncope from orthostatic hypotension during the reambulation period.
Résumé
Un patient atteint d’hypotension orthostatique idiopathique recevant un traitement oral chronique à la midodrine à requis l’anesthésie pour pontage aorlocoronarien. line perfusion périopératoire de phényléphrine fut substituté à la midodrine, un agoniste alpha 2, a pertnis à l’hypotension résultant d’une résistance vasculaire systémique basse d’être contrôlée facilement. On à noté une hypersensivité de dénervation des récepteurs adrénergiques. Le seul problemè périopératoire significatif fut une épisode de syncope due à une hypotension orthostatique lorsque le patient à repris ses activités normales.
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References
Bradbury S, Eggleston C. Postural hypotension: report of three cases. Am Heart J 1925; 1: 73–86.
Bannister R. Chronic autonomic failure with postural hypotension. Lancet 1979; 2: 404–6.
Schirger A, Sheps SG, Thomas JE, Fealey RD. Midodrine — a new agent in the management of idiopathic orthostatic hypotension and the Shy-Drager syndrome. Mayo Clin Proc 1981; 56: 429–33.
Cohen CA. Anesthetic management of a patient with the Shy-Drager syndrome. Anesthesiology 1970; 35: 95–7.
Malan MD, Crago RR. Anaesthetic considerations in idiopathic orthostatic hypotension and the Shy-Drager syndrome. Can Anaesth Soc J 1979; 26: 322–7.
Bevan DR. Shy-Drager Syndrome. Anaesthesia 1979; 34: 866–73.
Stirt JA, Frantz RA, Gunz EF, Conolly ME. Anesthesia, catecholamines and hemodynamics in autonomic dysfunction. Anesth Analg 1982; 61: 701–4.
Hutchinson RC, Sugden JC. Anaesthesia for Shy-Drager syndrome. Anaesthesia 1984; 39: 1229–31.
Sweeney BP, Jones S, Langford RM. Anaesthesia in dysautonomia: further complications. Anaesthesia 1985; 40: 783–6.
Niakan E, Haradi Y, Comstock JP. Diabetic autonomic neuropathy. Metabolism 1986; 35: 224–34.
Heinrich WL. Autonomic insufficiency. Arch Intern Med 1982; 142: 339–44.
Zeigler MG, Lake CR, Kopin U. The sympathetic nervous system defect in primary orthostatic hypotension. N Engl J Med 1977; 296: 293–7.
Hoeldtke RD, Cavanaugh ST, Hughes JD, Polansky M. Treatment of orthostatic hypotension with dihydroergotamine and caffeine. Ann Intern Med 1986; 105: 168–73.
Zachariah PK, Bloedow DC, Moyer TP Sheps SG, Schirger A, Fealey RD. Pharmacodynamics of midodrine, an antihypotensive agent. Clin Pharmacol Ther 1986; 39: 586–91.
Thulesius O, Gjores JE, Berlin E. Vasoconstrictor effect of midodrine, ST 1059, noradrenaline, etilefrine and dihydroergotamine on isolated human veins. Eur J Clin Pharmacol 1979; 16: 423–4.
Pinner H. Vasoconstrictor effects of midodrine, ST 1059, noradrenaline, etilefrine and norfenefrine on isolated dog femoral arteries and veins. Gen Pharmacol 1983; 14: 107–9.
Waller JL. Inotropes and vasopressors.In: Kaplan JA (Ed.). Cardiac Anesthesia, 1st ed. New York: Grune & Stratton 1983; 282.
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Osborne, P.J., Lee, L.W. Idiopathic orthostatic hypotension, midodrine, and anaesthesia. Can J Anaesth 38, 499–501 (1991). https://doi.org/10.1007/BF03007588
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DOI: https://doi.org/10.1007/BF03007588