FloTrac/EV1000 guided management of amlodipine induced refractory hypotension during renal transplantation

ABSTRACT

Patients scheduled to undergo renal transplantation are often the most complex ones that an anaesthesiologist may encounter, as intraoperative hemodynamic instability can adversely affect the outcome of renal transplantation. Amlodipine is the commonly prescribed drug to patients with end stage renal disease [ESRD] for control of hypertension. Preoperative use of amlodipine may rarely present as intraoperative hypotension. Amlodipine induced hypotension is usually refractory to commonly used vasopressors. Combination of calcium, different sympathomimetic agents and fluids with minimal invasive monitoring with FloTrac/EV 1000 can be helpful in this situation. It is important to titrate antihypertensive medications in perioperative period to prevent intraoperative hemodynamic instability during renal transplantation as it can affect the graft function. We report a case of successful management of intraoperative refractory hypotension after therapeutic dose of amlodipine during renal transplantation