Flomax causing intraop hypotension?

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Greenbayslacker

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I am wondering, based on tamsulosin's mechanism of action, why is it not regarded as a culprit for causing intraop hypotension? Direct a1 antagonism would in theory not only cause vasodilation but also block the action of phenylephrine. ACEI/ARBs are talked about ad nauseum with relation to hypotension, but I have never seen any mention of Flomax. There are some case reports out there of patients having low BP after starting the medication, but nothing about intraop effects.

EDIT: After further digging, tamsulosin hits the alpha 1-A receptors versus alpha 1-B in the vasculature
 
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I am wondering, based on tamsulosin's mechanism of action, why is it not regarded as a culprit for causing intraop hypotension? Direct a1 antagonism would in theory not only cause vasodilation but also block the action of phenylephrine. ACEI/ARBs are talked about ad nauseum with relation to hypotension, but I have never seen any mention of Flomax. There are some case reports out there of patients having low BP after starting the medication, but nothing about intraop effects.

EDIT: After further digging, tamsulosin hits the alpha 1-A receptors versus alpha 1-B in the vasculature
Though some people are dicks everywhere. 😛
 
I've seen severe vasoplegia after induction that couldn't be otherwise explained, after going through absolutely everything else on the differential and complete workup that's what we all chalked it up to.
 
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