Enalapril Premedication Attenuates the Blood Pressure Response to Tracheal Intubation and Stabilizes Postoperative Blood Pressure after Controlled Hypotension with Sodium Nitroprusside in Neurovascular Patients

Tohmo, H.; Karanko, Meri S.; Scheinin, Mika; Viinamäki, O; Salonen, Markku; Nieminen, V.

doi:10.1097/00008506-199301000-00003

Cited by 18 publications

(8 citation statements)

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“…In contrast, use of ACEI during surgery may be beneficial as it attenuates the adrenergic response to stressful stimuli in cardiac surgical patients [1], in vascular surgery patients [3], in those undergoing cerebrovascular surgeries [4], and in patients with impaired LV function [16]. In a recent study of 149 ambulatory surgical patients, Griffin et al [17] showed that discontinuation of ACEI treatment more than 10 hours versus less than 10 hours prior to surgery did not cause an increase in prevalence of preoperative hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative administration of angiotensin-converting enzyme inhibitors (ACEIs) may be beneficial as they attenuate the adrenergic response to stressful stimuli in a variety of patients undergoing cardiac [1], gynecological [2], vascular [3], and cerebrovascular [4] surgeries and in patients with impaired left ventricular (LV) function [4]. Patients taking ACEIs may require more vasopressors to maintain adequate blood pressure (BP) [5,6], and are reportedly at special risk of intraoperative hypotension, especially after anesthetic induction [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Dose-dependent hemodynamic effects of propofol induction following brotizolam premedication in hypertensive patients taking angiotensin-converting enzyme inhibitors

Weisenberg¹,

Sessler²,

Tavdi³

et al. 2010

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dose-dependent hemodynamic effects of propofol induction following brotizolam premedication in hypertensive patients taking angiotensin-converting enzyme inhibitors

Weisenberg¹,

Sessler²,

Tavdi³

et al. 2010

Journal of Clinical Anesthesia

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“…Tohmo et al described the use of preoperative enalapril as part of balanced hypotensive anaesthesia for cerebrovascular surgery 58. This is a technique in which controlled hypotension is used to minimise intraoperative bleeding and the need for transfusional support 59.…”

Section: Evidence Supporting Raas Antagonists In the Perioperative Sementioning

confidence: 99%

“…This is a technique in which controlled hypotension is used to minimise intraoperative bleeding and the need for transfusional support 59. Enalapril was associated with a decrease in the hypertensive response to intubation, lowered the requirements for postoperative vasodilators, and provided for more stable BP control compared with placebo 58. The authors theorised that preoperative fasting may be a more significant contributor to perioperative hypotension, and that the hypotension after induction of anaesthesia might be prevented by ensuring proper intravascular volume rather than withholding ACEIs before surgery 60…”

Section: Evidence Supporting Raas Antagonists In the Perioperative Sementioning

confidence: 99%

Renin–angiotensin system antagonists in the perioperative setting: clinical consequences and recommendations for practice

Aurón

Harte

Kumar

et al. 2011

Postgraduate Medical Journal

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There are no existing guidelines supporting the withdrawal or continuation of renineangiotensinealdosterone system (RAAS) antagonists in the preoperative setting. RAAS antagonists include ACE inhibitors, angiotensin II receptor subtype 1 blockers and direct renin inhibitors (eg, aliskiren), as well as the aldosterone antagonists. The use of these agents before surgery has been associated with a variable incidence of hypotension during the initial 30 min after induction of anaesthesia; however, these hypotensive episodes have not been conclusively linked to any significant postoperative complications, although recent data suggest an increase in postoperative morbidity and mortality in patients undergoing coronary artery bypass grafting. Further studies are required to be able to demonstrate if the organ-protective benefits of RAAS antagonists justify their continuation in the perioperative setting. Temporary withdrawal of RAAS antagonists in these patients may prevent or attenuate intraoperative hypotension and hypovolaemia. Alternatively, the increase in RAAS activity and blood pressure expected with cessation of RAAS antagonist therapy may impair regional circulation secondary to an increase in systemic vascular resistance. Full discussion of the potential implications of perioperative RAAS antagonist therapy with the surgical team is important, and strategies to ensure careful monitoring and maintenance of adequate intravenous volume before induction of anaesthesia are essential.

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“…However, few studies address this question in vivo and the results remain conflicting. In patients undergoing anesthesia, pretreatment with enalaprilat has no significant effect on plasma endothelin concentration [9]. Finally in CHF, only one noncontrolled study investigated plasma ET-1 in patients under oral quinapril or captopril treatment, and did not show any significant variation after 16 weeks of chronic treatment [10].…”

Section: Discussionmentioning

confidence: 98%

Captopril does not acutely modulate plasma endothelin-1 concentration in human congestive heart failure

Grenier

Pousset

Isnard

et al. 1996

Cardiovasc Drug Ther

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Congestive heart failure (CHF) is a syndrome characterized by increased levels of angiotensin II (Ang II) and endothelin-1 (ET-1). In vitro, Ang II stimulates ET-1 release. The purpose of the study was to assess the effect of a single dose of an angiotensin-converting enzyme inhibitor (ACEI) captopril versus placebo on plasma endothelin concentration in human congestive heart failure. Captopril (25 mg, given orally) was compared with placebo in a group of 20 patients with systolic dysfunction in a double-blind randomized study. Plasma irET concentration was significantly increased in CHF patients compared with normal subjects (5.59 pg/ml +/- 0.35 vs. 3.58 pg/ml +/- 0.99, p < 0.0002). Despite the decrease in systolic blood pressure and the increase in plasma renin activity, suggesting a significant blockade of the renin-angiotensin system, no difference in plasma irET-1 was observed between captopril and placebo. Our results suggest that captopril does not acutely influence irET-1 plasma concentration in human CHF. These data do not support the hypothesis that the acute vasodilator effect of a single dose of 25 mg of captopril given daily orally involves modulation of the increased plasma concentration of endothelin observed in CHF.

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Enalapril Premedication Attenuates the Blood Pressure Response to Tracheal Intubation and Stabilizes Postoperative Blood Pressure after Controlled Hypotension with Sodium Nitroprusside in Neurovascular Patients

Cited by 18 publications

References 0 publications

Dose-dependent hemodynamic effects of propofol induction following brotizolam premedication in hypertensive patients taking angiotensin-converting enzyme inhibitors

Dose-dependent hemodynamic effects of propofol induction following brotizolam premedication in hypertensive patients taking angiotensin-converting enzyme inhibitors

Renin–angiotensin system antagonists in the perioperative setting: clinical consequences and recommendations for practice

Captopril does not acutely modulate plasma endothelin-1 concentration in human congestive heart failure

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