The Association Between Preoperative Tamsulosin Use and Intraoperative Hypotension

To determine whether preoperative use of tamsulosin is associated with hypotension during cardiopulmonary bypass (CPB) surgery.

Retrospective observational cohort design.

A tertiary referral hospital.

159 male patients, 40-90 years old, who underwent coronary artery bypass graft or valve replacement surgery at the authors' hospital from April 1, 2021 to May 31, 2022.

Preoperative use of tamsulosin in male patients undergoing coronary artery bypass graft or valve replacement surgery.

Groups were based on preoperative tamsulosin use: tamsulosin use within 24 hours before bypass (n = 41) versus no tamsulosin use before surgery (n = 118). The primary outcome was vasopressor use in 30-minute time periods during CPB and upon arrival in the intensive care unit (ICU). Unadjusted and adjusted linear mixed-effects models were used to examine vasopressor use over time and across groups. The unadjusted model showed that preoperative tamsulosin users required significantly greater vasopressor support during all bypass time periods (all p ≤ 0.006) and upon ICU arrival (p = 0.014) than did the no tamsulosin group. An effect of preoperative tamsulosin remained after adjusting for risk factors associated with vasoplegia. Compared with nonusers, the tamsulosin group required significantly greater vasopressor support across all bypass time periods (p < 0.001-0.033).

This study suggests that the use of tamsulosin prior to cardiac surgery is associated with an increased requirement for vasoactive support during CPB and upon ICU arrival. Prospective studies are warranted.