Persistent Postoperative Hypotension Following Total Hip Replacement in a Patient with Schizophrenia

We report the case of a middle-aged male patient with schizophrenia on long-term antipsychotic therapy who underwent a complex primary total hip replacement. The patient developed persistent postoperative hypotension despite stable intraoperative haemodynamics and no evidence of bleeding or hypovolaemia. Drug-induced vasodilation secondary to alpha-adrenergic blockade from first-generation antipsychotics was considered the most likely cause. Blood pressure responded promptly to metaraminol infusion. This case highlights the importance of recognising medication-related vasoplegia, maintaining a broad differential diagnosis for postoperative hypotension, and considering early vasopressor therapy and escalation of care when required.