Use of Intramuscular Ephedrine Sulfate During Kidney Transplantation

• Authors: Gaurav Patel, Emory University; Susan Smith, Emory University; Michelle Romej, Emory University; Billynda McAdoo, Emory University; Elizabeth Wilson, Emory University
• Journal Title: Clinical Pharmacology: Advances and Applications
• Volume: Volume 15
• Publisher: Dove Press Ltd | 2023-01-01, Pages 57-61
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2147/CPAA.S418124
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: general anesthesia; hypotension; intramuscular ephedrine; kidney transplant; perfusion pressure

Abstract

Hypotension during kidney transplantation can be common. Vasopressor use during these procedures is often avoided, with a fear of decreasing renal perfusion in the transplanted kidney. However, adequate perfusion for the rest of the body is also necessary, and given that these patients often have underlying hypertension or other comorbid conditions, an appropriate mean arterial pressure (MAP) has to be maintained. Intramuscular injections of ephedrine have been studied in the anesthesiology literature in a variety of case types, and it is seen as a safe and effective method to boost MAP. We present a case series of three patients who underwent renal transplantation and who received an intramuscular injection of ephedrine for hypotension control. The medication worked well for increasing blood pressures without apparent side effects. All three patients were followed for more than one year, and all patients had good graft function at the end of that time period. This series shows that while further research is necessary in this arena, intramuscular ephedrine may have a place in the management of persistent hypotension in the operating room during kidney transplantation.