Effect of pre-operative discontinuation of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists on intra-operative arterial pressures after induction of general anesthesia

Abstract

Context:Medical guidelines advise perioperative continuation many antihypertensives, but discontinuing angiotensin antagonists before surgery.Aims:This study is aimed to determine the effect of preoperative discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA) on intra-operative blood pressure after induction of general anesthesia.Settings and Design:The study was a randomized, prospective and double blinded one done in 60 hypertensive patients, receiving these drugs.Materials and Methods:Patients were randomized into two equal groups. In Group A, ACEI or angiotensin II receptor antagonist was stopped the day before surgery, but in Group B it was continued. Anesthetic management was standardized by a study protocol. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured just before induction and after induction at 1 min, 3, 5, 10, 15, 30, 45 and 60 min.Statistical Analysis:Difference between means and difference between two proportions was analyzed using Normal test for means and corresponding P values were calculated.Results:Pre-induction SBP, DBP and MAP were comparable between groups. However when the pre-induction values were compared with subsequent readings at 3, 5, 10, 15, 30, 45 and 60 min, it was found that there was a significant reduction in SBP, DBP and MAP in Group B up to 60 min.Conclusions:Intraoperative hemodynamics can be safely managed when ACEI or ARA are withheld on the day of surgery.

Prospective randomized study to compare between intravenous dexmedetomidine and esmolol for attenuation of hemodynamic response to endotracheal intubation

“…Profound hypotension following anesthetic induction in these patients with ACE inhibitors has been noted in previous studies. [ 20 21 ] The inclusion of such patients will confound the hemodynamic response to intubation either with or without stopping the ACE inhibitor in the morning of surgery. Hence, we included ASA I patients alone.…”

Frequency of Intraoperative Hypotension After the Induction of Anesthesia in Hypertensive Patients with Preoperative Angiotensin-converting Enzyme Inhibitors

“…They concluded that ACE inhibitor therapy should be ceased at least 10 hours before surgery. A randomized, prospective, double-blinded study was conducted by Rajgopal in 2014, which included 60 patients, and the aim was to determine the effect of the discontinuation of ACE inhibitors on the intraoperative hypotension after the induction of general anesthesia [16].…”