Typically, patients adapt to a lower BP over time; some may experience bradycardia from unopposed vagal flow. Vasopressors that raise the heart rate may offer some benefit during the initial hemodynamic push. Such medications as enteral albuterol have been used to increase the heart rate in patients with persistent symptomatic bradycardia.
Stimulation of the vasovagal reflex may lead to cardiac arrest, requiring emergency atropine administration. To help prevent asystole episodes, hyperoxygenate the patient before turning or suctioning (unless contraindicated). Cardiac pacing has been used in patients whose hypotension fails to resolve over time or who require frequent doses of anticholinergic drugs.