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Ephedrine is a medication used to manage and treat clinically significant hypotension. It is in the sympathomimetic class of drugs. The FDA-approved primary indication for ephedrine is the treatment of clinically significant hypotension perioperatively. Induction of general anesthesia and ongoing anesthesia during operative cases results in vasodilatation and hypotension, requiring treatment with vasopressors. This activity illustrates ephedrine's indications, action, and contraindications in treating clinically significant hypotension. This activity highlights the mechanism of action, administration, contraindications, adverse event profile, and other key factors pertinent to interprofessional healthcare team members involved in caring for patients with clinically significant hypotension and related conditions. Objectives: Identify the indications for treatment with ephedrine. Recognize common complications of managing clinically significant hypotension intraoperatively with ephedrine. Identify alternative options to treat significant intraoperative hypotension. Apply effective interprofessional team communication to improve outcomes for the patient requiring ephedrine. Access free multiple choice questions on this topic.

According to the manufacturer's prescribing information, an overdose of ephedrine can cause a rapid rise in blood pressure. In the case of an overdose, careful blood pressure monitoring is recommended. If blood pressure rises to an unacceptable level, parenteral antihypertensive agents can be administered at the clinician's discretion. Signs and Symptoms: The principal manifestation of ephedrine poisoning is hypertension and convulsions. A case report of cardiomyopathy and spinal artery vasospasm leading to quadriplegia has been noted.[34] Treatment: If respirations are shallow or cyanosis is present, secure the airway and provide mechanical ventilation. Antidote: For hypertension, 5 mg phentolamine mesylate diluted in saline may be administered slowly intravenously, or clinicians may give 100 mg orally. Convulsions may be controlled by benzodiazepines.

Though anesthetists and certified registered nurse anesthetists (CRNA) are some of the only providers to administer ephedrine routinely, they do not do so within a vacuum. All interprofessional healthcare team members, including physicians, mid-level practitioners, nurses, and pharmacists providing care for the patient, should know its effects and different routes of administration. When given intravenously, drug effects are often of short duration (minutes), and tachyphylaxis is common. However, if given intramuscularly, the vasopressor effects typically remain for 60 to 90 minutes.[13] These effects are significant in the labor and delivery ward. Patients often receive intramuscular ephedrine injections following a spinal block to attenuate the sympathectomy and nausea that frequently accompany spinal blockade. The effects of an IM injection may last much longer than the procedure itself, and nurses and clinicians should not rely on hypotension as the primary indicator of postpartum hemorrhage, as IM ephedrine may mask this sign. When planning to use ephedrine, the pharmacist should verify the dose and that there are no significant drug-drug interactions and report these findings to the clinical team. Nursing must be mindful of the adverse effects of the drug and be prepared to inform the clinician regarding their observations. Nurse anesthetists (CRNAs) are also commonly involved in administration, so they must collaborate on dosing and administration with the pharmacist. Monitoring the patient following administration is the responsibility of all team members, and they must all be empowered to speak up if there are any concerns so interventions can be initiated if necessary. These examples show how all interprofessional team members, including MDs, DOs, NPs, PAs, nurses, specialists, and pharmacists, can optimize outcomes related to ephedrine therapy while mitigating its adverse effects. [Level 5]