Flomax causing intraop hypotension?

[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

 

[deleted1147063]

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. 😛

 

[nimbus]

All I know is ophtho hates it.

 

[CubsDynasty]

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.

 

[coffeebythelake]

All I know is ophtho hates it.

Floppy iris syndrome

 

[PpfSuxTube]

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.

Did you have a swan or tee?