Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesiaHypotension associated with epidural analgesia can have detrimentaleffects on the surgical anastomosis and in patients with cardiac, renalor cerebrovascular disease.Metaraminol is a vasoconstrictor which can be administered byperipheral infusion in a low dose to partially reverse the vasodilatationcaused by the epidural, decreasing the need for repeated fluidboluses and improving gut perfusion and therefore, the healingprocess.Hypotension due to other causes such as bleeding and hypovolaemiawill not be masked by a low dose infusion.Patients who require infusions that deviate from these guidelinesshould usually be managed on HDU.Administration guidelines1. All infusions will be 20 mg metaraminol in 40 mL 0.9% normalsaline given by infusion pump attached to a cannula with arunning IVI which is protected from retrograde infusion by a onewayvalve.2. Infusions must not be given through a separate peripheralcannula, but may be given through a dedicated lumen of acentral line. If the Venflon tissues, the infusion must be stoppedand the Venflon resited urgently.3. The infusion will usually be started by the anaesthetist in theatreor PACU who will determine the start rate – in the range0-5 mL h -1 .4. The rate of the infusion and the volume remaining must bedocumented hourly on a pump infusion chart.5. The infusion must be clearly prescribed on the reverse of thedrug chart.6. Glycopyrrolate 200 µg IV should be prescribed on the reverse ofthe drug chart to be used if the pulse rate falls below 40 bpm.Anaesthetists Handbook January 2010 131