Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirements

Abstract

Adverse events during coronary artery bypass graft (CABG) surgery have been described in patients receiving angiotensin converting enzyme (ACE) inhibitors, including hypotension on induction of anaesthesia and an increase in vasoconstrictor requirements after cardiopulmonary bypass (CPB). Omitting regular ACE inhibitor medication before surgery may improve cardiovascular stability during anaesthesia. We evaluated prospectively the effect of omitting regular ACE inhibitor medication before CABG surgery on haemodynamic variables and use of vasoactive drugs. We studied 40 patients with good left ventricular function, allocated randomly to omit or continue ACE inhibitor medication before surgery. Arterial pressure, cardiac output, systemic vascular resistance and use of vasoactive drugs were recorded during anaesthesia and in the early postoperative period. Patients who omitted their ACE inhibitors had greater mean arterial pressure during the study and required less vasopressors during CPB. However, these patients required more vasodilators to control hypertension after CPB and in the early postoperative period. There was no difference in hypotension on induction of anaesthesia or in the use of vasoconstrictors after CPB. We conclude that omitting ACE inhibitors before surgery did not have sufficient advantage to be recommended routinely.

Outcome of Renal Insufficiency Patients Undergoing Coronary Artery Bypass Graft Surgery

“…Two clinical trials have studied this issue. They have shown that there is increased need for vasopressors in an ACEI group compared to a control group without ACEI (where ACEI was discontinued 12–24 h before surgery) [18, 19]. Hypertensive episodes postoperatively were the same in both groups in one study [18], but higher in the ACEI-discontinued group in the other study [19].…”

“…They have shown that there is increased need for vasopressors in an ACEI group compared to a control group without ACEI (where ACEI was discontinued 12–24 h before surgery) [18, 19]. Hypertensive episodes postoperatively were the same in both groups in one study [18], but higher in the ACEI-discontinued group in the other study [19]. In our study, ACEI was discontinued 24 h prior to CABG surgery, as suggested by previous studies that ACEI might blunt the compensatory activation of the renin-angiotensin system during surgery and result in prolonged hypotension.…”

Effect of Isoflurane Anesthesia on Hemodynamics Following the Administration of an Angiotensin-Converting Enzyme Inhibitor in Cats

“…General anesthetics can lower blood pressure in patients receiving ACE inhibitor which is an antihypertensive medication, or angiotensin II receptor antagonist [1,2,5,12,13]. Therefore, severe hypotension may occur during anesthesia in cats when ACE inhibitor is required for the diagnosis or treatment procedure.…”

The Application of Angiotensin Converting Enzyme Inhibitors in Heart Surgery

“…In recent articles of both animal [23] and human studies [24,25], a role of bradykinin is attenuated during ischemia and reperfusion in hypothermic condition. Post-operative hypotension can be avoided even after acute administration of ACE inhibition when choice of ACE inhibitor and administration dose are adequate and maybe when in hypothermic condition [26]. Indeed, when low dose of enalaprilat (less than 30 % of CONSENSUS II) was injected before ischemia, beneficial effect was confirmed after cardiac surgery [20,27].…”