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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 306-311
DOI: 10.1055/s-0043-1769755
Original Article

Oral Midodrine as an Adjunct in Rapid Weaning of Intravenous Vasopressor Support in Spinal Cord Injury

Arunkumar Sekar 
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Odisha, India
,
Debajyoti Datta
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Odisha, India
,
Avinash Lakha
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Odisha, India
,
Sritam Swaroop Jena
2   Department of Anesthesiology, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Odisha, India
,
Sumit Bansal
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Odisha, India
,
Rabi Narayan Sahu
1   Department of Neurosurgery, All India Institute of Medical Sciences – Bhubaneswar, Bhubaneswar, Odisha, India
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Abstract

Background Majority of acute cervical spinal cord injury end up requiring long-term stay in intensive care unit (ICU). During the initial few days after spinal cord injury, most patients are hemodynamically unstable requiring intravenous vasopressors. However, many studies have noted that long-term intravenous vasopressors remain the main reason for prolongation of ICU stay. In this series, we report the effect of using oral midodrine in reducing the amount and duration of intravenous vasopressors in patients with acute cervical spinal cord injury.

Materials and Methods Five adult patients with cervical spinal cord injury after initial evaluation and surgical stabilization are assessed for the need for intravenous vasopressors. If patients continue to need intravenous vasopressors for more than 24 hours, they were started on oral midodrine. Its effect on weaning of intravenous vasopressors was assessed.

Results Patients with systemic and intracranial injury were excluded from the study. Midodrine helped in weaning of intravenous vasopressors in the first 24 to 48 hours and helped in complete weaning of intravenous vasopressors. The rate of reduction was between 0.5 and 2.0 µg/min.

Conclusion Oral midodrine does have an effect in reduction of intravenous vasopressors for patients needing prolonged support after cervical spine injury. The real extent of this effect needs to be studied with collaboration of multiple centers dealing with spinal injuries. The approach seems to be a viable alternative to rapidly wean intravenous vasopressors and reduce duration of ICU stay.

Keywords

cervical spine injury - neurogenic shock - neurointensive care - refractory hypotension - spinal cord injury

Ethical Approval

AIIMS Bhubaneswar Institute ethical committee. T/I-MF/21-22/21.




Publication History

Article published online:
16 June 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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