Abstract
IntroductionTamsulosin, a selective α1-adrenergic receptor (α1-AR) antagonist, is a widely prescribed first-line agent for benign prostatic hypertrophy (BPH). Its interaction with anesthetic agents has not been described.Case presentationWe report the case of 54-year-old Asian man undergoing elective left thyroid lobectomy. The only medication the patient was taking was tamsulosin 0.4 mg for the past year for BPH. He developed persistent hypotension during the maintenance phase of anesthesia while receiving oxygen, nitrous oxide and 1% isoflurane. The hypotension could have been attributable to a possible interaction between inhalational anesthetic and tamsulosin.ConclusionVigilance for unexpected hypotension is important in surgical patients who are treated with selective α1-AR blockers. If hypotension occurs, vasopressors that act directly on adrenergic receptors could be more effective.
Highlights
Tamsulosin, a selective a1-adrenergic receptor (a1-AR) antagonist, is a widely prescribed first-line agent for benign prostatic hypertrophy (BPH)
Vigilance for unexpected hypotension is important in surgical patients who are treated with selective a1-AR blockers
Tamsulosin is a uroselective a1Aadrenergic receptor (a1A-AR) antagonist primarily used for patients with benign prostatic hyperplasia (BPH) presenting with lower urinary tract symptoms [1]
Summary
Tamsulosin (benzenesulfonamide) is a uroselective a1Aadrenergic receptor (a1A-AR) antagonist primarily used for patients with benign prostatic hyperplasia (BPH) presenting with lower urinary tract symptoms [1]. The patient’s recorded blood pressure (BP) was 137/88 mm Hg, heart rate was 72 bpm, and temperature was 36.5°C. General anesthesia was maintained with O2/N2O and isoflurane minimum alveolar concentration (MAC) of 0.8% At this point, the differential diagnosis of hypotension was primarily directed to deep anesthesia or hypovolemia. The patient’s trachea was extubated, and he was shifted to the postanesthesia care unit He remained in the recovery room for two hours and remained hemodynamically stable with BP in the range of 120/75 to 140/80 mm Hg and heart rate between 70 and 76 bpm
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