opinions

[confusionabounds]

looking for opinions - let's say you have a pt. on beta blockers. they come in for surgery and their HR is in the 60's-70's (which is their baseline) and their pressure is in the 70's/40's range. you've given fluid, blah, blah blah. my question is, which would be more appropriate for a pt on beta blockers to get, ephedrine or neosynephrine - to increase their bp? neo is of course a direct alpha agonist, so you have that going for you. ephedrine has some alpha action as well as beta action which would compete with the beta blockers for sites and reduce their effect, yada, yada, yada. any opinions?

[athomas91]

the thread "sidetracked" after the question was answered....neo....

as for hetastarch - the coagulation effects are "negligible" per the literature - i have not done anesthesia long enough to have my own findings so i cannot comment. however, when i have a pt w/ normal coags (or near normal) i have found the colloid goes a long way as compared to crystalloid in acheiving my goals of maintaining intravascular volume without causing undue pulmonary/interstitial issues. i am thankful i practice currently in a facility that allows us to use what we need - i know some don't due to cost.

[jdpete]

thanks for the cme's

[ZASHAGALKA, RN]

thanks for the cme's

Now see that's what I was sincerely thinking, without the hint of sarcasm.

LOL, it's all good.

~faith,

Timothy.

[athomas91]

ok - so say we don't address all the other possibilities underlying the hypotension....

we give neo - surgeon cut - bp 180/100... are you going to chase your tail and give a beta blocker...then neo...then a beta blocker...then ephedrine....

i agree w/ mike - the whole scenario needs to be accounted for - the origional quesiton was answered in simplicity by a multitude of people - going more in depth only leads to critical thinking and better practitioners... i don't see the problem with that.

[jdpete]

good points all the way around, and you are right with learning new things, I really was more messing around, I didn't mean for it to sound as malicious as it did :)

[athomas91]

ok - thanks for the clarity. :)

[mwbeah]

LOL, it's all good.

~faith,

Timothy.

You are so right, its allllllllllllllll good!

Mike:wink2:

[confusionabounds]

wow, good stuff, folks. thanks for the replies to my original question. i really did mean it as a simple question, and my intention was not to have anyone nerd out on me with a million scenarios, but i always do that as well when i am asked a question-i ask for more info. anyway, to satisfy the curious, my pt. was a middle aged male, middle of surgery, actively being cut, gas has already been turned down, very well hydrated already, not much blood loss to speak of, no tourniquet was used, yada, yada, yada. His bp just dropped on me, and i did everything i could to raise it before i gave ephedrine or neo. as i was reaching for my drug of choice (in this case) i ran through all the pros and cons of using both in my now hypotensive beta blocked pt. just thought i would get some opinions as to what everyone thought. By the way, i used neo (if anyone cares) ephedrine would have worked as well if not better (competition for sites and all that) but i chose not to use it due to the reasoning mentioned earlier - they were beta blocked for a reason and i didn't want to counter act too much of that if i could help it. anyway, thanks for all the replies.