Post-operative UGIB
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Acetylcholine (ACh) given IV causes vasodilation (via endothelial NO) and bradycardia (direct and reflex), lowering BP. Ganglion blockade does not affect the direct endothelial/muscarinic vascular action of ACh, so the fall persists or is enhanced (due to loss of compensatory reflexes). Muscarinic blockade (with atropine) blocks the vascular M3 receptors needed for NO-mediated vasodilation, abolishing the hypotensive effect.
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