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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Metaraminol is an unusual vasoactive medication in that it can be administered via a peripheral line. It acts as an alpha receptor agonist, causing peripheral vasoconstriction, and is used in the emergency treatment of hypotension. It has a longer half-life than standard medications such as noradrenaline, so small doses can be administered as an IV bolus (NICE 2019). This drug can be useful in situations such as a drop in systemic vascular resistance and BP post-epidural anaesthesia. Cardiovascular monitoring is necessary, but this may be possible with automated non-invasive BP monitoring devices in an enhanced level 1 location if only short-term support is required. It is sometimes used as a continuous peripheral infusion, but as yet, there is little evidence to support its longer-term use (Anderson and Chatha 2017). If cardiovascular support requirements continue, it is appropriate to transfer the patient to a higher level of care for the insertion of a central and arterial lines, enabling infusion and close monitoring of drugs such a noradrenaline.
Drug therapy in the cardiac catheterisation laboratory: A guide to commonly used drugs
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
John Edward Boland, Fuyue Jiang, Andrew Fenning
The sedative lorazepam and contrast media also lower blood pressure as a side effect. Blood pressure can also drop during coronary angiography as a result of a catheter blocking blood supply during positioning. Metaraminol (see below) is a useful, short-acting agent that may be used to ameliorate hypertension if severe or symptomatic.
Emergency drugs
Published in Daniel Cottle, Shondipon Laha, Peter Nightingale, Anaesthetics for Junior Doctors and Allied Professionals, 2018
Metaraminol is a very potent drug and must be diluted and used with care. Vials contain 10 mg in 1 mL. Dilute into 20 mL of normal saline to make a concentration of 0.5 mg/mL.Bolus doses of 0.2–0.5 mg (0.5–1 mL) can be used to increase BP – start with low doses, some patients are very sensitive to even a small bolus. Action is within 1–2 minutes; you will usually see the HR reduce initially.Metaraminol can be used by infusion (10 mg in 50 mL of normal saline) and the dose titrated to the patient’s BP.
Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report
Published in Cochlear Implants International, 2021
Rohma Abrar, Deborah Mawman, Unai Martinez de Estibariz, Devjay Datta, Emma Stapleton
Our patient therefore underwent bilateral cochlear implantation under LA in January 2020 for his profound sensorineural deafness. Facial nerve monitoring was not used. His carer was present in the operating theatre and helped with non-verbal communication during the procedure, for example hand squeezes were agreed to indicate pain and need to pause, though these were not required. A target control infusion of intravenous propofol 1% and remifentanil was used to achieve conscious sedation. The patient also received metaraminol infusion and ephedrine bolus to support his blood pressure during the procedure. 4mg IV dexamethasone was administered at the start of the procedure. The first dose of antibiotics (co-amoxiclav) was given at the start of the procedure. Pain control was supplemented with intravenous paracetamol. Humidified high flow nasal oxygen at 30 L/min was given for oxygenation and no desaturation was noted during the procedure. A consultant anaesthetist was present throughout, providing close physiological and cardiological monitoring.
An overview of emergency pharmacotherapy for priapism
Published in Expert Opinion on Pharmacotherapy, 2022
Graham A. Bobo, Wael Almajed, Jack Conlon, Rohan A. Morenas, Wayne J.G Hellstrom
Metaraminol administered at dosages of 4 mg or higher is associated with increased heart rates and blood pressure, which must be actively monitored. Given its established potency in the treatment of priapism, case reports determined this drug as a safe option for self-treating patients with recurrent priapism [39].
High-dose insulin euglycemic therapy to treat cardiomyopathy associated with massive venlafaxine overdose
Published in Clinical Toxicology, 2020
Maurizio Stefani, Darren M. Roberts, Jonathan Brett
A 44-year-old woman weighing 68 kg ingested 25.2 g of venlafaxine extended release plus an unknown quantity of temazepam within 4 h prior to presentation. Initially, she was disoriented and tachycardic, with a normal venous blood gas. At 2 h post-presentation, she developed dilated pupils and myoclonic jerks. Over the next 4 h, she suffered three generalized tonic-clonic seizures, receiving midazolam 2.5 mg and diazepam 20 mg IV. After the final seizure, her Glasgow Coma Scale was 6, HR 98 bpm and BP 80/60 mmHg, with lactate 3.1 mmol/L. She was treated with metaraminol 1 mg IV and 1 L of IV crystalloid, and she was intubated. Activated charcoal 50 g was administered via nasogastric tube. One hour later, the BP decreased again to 64/40 mmHg despite an additional litre of crystalloid, wherefore a noradrenaline infusion was commenced and uptitrated to 10 µg/min. The patient had developed left ventricular (LV) failure confirmed by transthoracic echocardiogram showing global LV systolic dysfunction (ejection fraction 30%). The oxygen saturation was 90% on PEEP 7 cm H2O and FiO2 90%. HIET was then initiated to reduce catecholamine exposure, with a 70 unit (1 unit/kg) bolus and 70 units/h infusion of Actrapid (soluble insulin) along with 50% dextrose IV at a median rate of 25 ml/h. Systolic BP stabilized between 90 and 120 mmHg over the next 5 h with insulin uptitrated to 150 units/h and noradrenaline able to be reduced to 1.3 µg/min. At 9 h, post-presentation her lactate again rose peaking at 4.3 mmol/L with nadir pH 7.29, with resolution without additional treatment by 16 h. She also developed QRS complex prolongation of 140 ms on ECG at this time. Whole bowel irrigation was administered at 10 h with tablets noted in the effluent within 4 h. A new echocardiogram at 12 h showed an improved LV ejection fraction of 55–60%. ECG changes resolved at 21 h, and insulin and noradrenaline were ceased at 22 h. Hypoglycaemia did not occur during HIET administration. Her lowest recorded blood glucose was 3.3 mmol/L at 5 h post-overdose, however the dextrose infusion was continued for at least 12 h post-cessation of HIET. She was extubated at 40 h, delayed due to delirium, and discharged home with a complete neurological recovery on day 14.