Effect of Preoperative Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use on Hemodynamic Variables in Pediatric Patients Undergoing Cardiopulmonary Bypass

Ajuba-Iwuji, Chinwe; Puttreddy, Sahitya; Maxwell, Bryan G.; Bembea, Melania M.; Heitmiller, Eugenie S.

doi:10.1177/2150135114549748

Cited by 7 publications

(2 citation statements)

References 26 publications

(45 reference statements)

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“…38 The presurgical management of these drugs in children is not well characterized, with most centers advising discontinuation the day before surgery if possible. 39 Low-dose aspirin is often well tolerated during superficial surgical procedures but is held ≥5 days before major surgical procedures because of the potential for bleeding. 40 In contrast, patients on warfarin may need to be either transitioned to subcutaneous therapy in the outpatient setting or admitted for conversion to intravenous heparin.…”

Section: Preoperative Evaluation Before Noncardiac Surgerymentioning

confidence: 99%

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Nasr¹,

Markham²,

Clay³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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Continuous advances in pediatric cardiology, surgery, and critical care have significantly improved survival rates for children and adults with congenital heart disease. Paradoxically, the resulting increase in longevity has expanded the prevalence of both repaired and unrepaired congenital heart disease and has escalated the need for diagnostic and interventional procedures. Because of this expansion in prevalence, anesthesiologists, pediatricians, and other health care professionals increasingly encounter patients with congenital heart disease or other pediatric cardiac diseases who are presenting for surgical treatment of unrelated, noncardiac disease. Patients with congenital heart disease are at high risk for mortality, complications, and reoperation after noncardiac procedures. Rigorous study of risk factors and outcomes has identified subsets of patients with minor, major, and severe congenital heart disease who may have higher-than-baseline risk when undergoing noncardiac procedures, and this has led to the development of risk prediction scores specific to this population. This scientific statement reviews contemporary data on risk from noncardiac procedures, focusing on pediatric patients with congenital heart disease and describing current knowledge on the subject. This scientific statement also addresses preoperative evaluation and testing, perioperative considerations, and postoperative care in this unique patient population and highlights relevant aspects of the pathophysiology of selected conditions that can influence perioperative care and patient management.

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Section: Preoperative Evaluation Before Noncardiac Surgerymentioning

confidence: 99%

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Nasr¹,

Markham²,

Clay³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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“…The association between angiotensin converting enzyme inhibitors (ACEI) and post-operative hypotension was first recognized more than two decades ago in adults ( 6 , 7 ). In a previous study Ajuba-Iwuji et al reported that preoperative ACE inhibitor and ARB use in pediatric patients undergoing cardiac surgery did not significantly increase the incidence of hypotension after induction of anesthesia and did not significantly increase vasoconstrictor requirements upon weaning from CPB; however, patients on ACE inhibitor/ARB therapy tended to have a higher VIS than patients in the control group ( 8 ). This study has important limitations acknowledged by the authors including small and discrepant sample size (18 vs. 132), unmatched groups of patients, different mean age (6.4 ± 6.1 years vs. 4.3 ± 5.5 years), unmatched diagnosis, potential of under reporting and recording bias and combining patients taking ACEI and ARB into one group (both these drugs act at different levels).…”

Section: Discussionmentioning

confidence: 98%

Prolonged Postoperative Vasoplegia in Pediatric Patients on Chronic Angiotensin II Blocker Treatment

Pandya

Alphonso

et al. 2018

Front. Cardiovasc. Med.

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Prolonged postoperative vasoplegia is known to occur following cardiac surgery in patients on chronic angiotensin II receptor blocker (ARB) treatment in adults. The perioperative management of these drugs in the pediatric population is not well described and here we would like to highlight this fact. While ARBs are increasingly used in children and adolescents with hypertension, there is lack of data to guide optimal pre-surgical management in the pediatric age group. We report two cases of prolonged vasoplegia following cardiopulmonary bypass occurring in adolescent patients on chronic ARB therapy and the importance of cessation of these drugs preoperatively.

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Preoperative Preparation

Cladis¹,

Davis²

2017

Smith's Anesthesia for Infants and Children

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Effect of Preoperative Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use on Hemodynamic Variables in Pediatric Patients Undergoing Cardiopulmonary Bypass

Cited by 7 publications

References 26 publications

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association

Prolonged Postoperative Vasoplegia in Pediatric Patients on Chronic Angiotensin II Blocker Treatment

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