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

Salim, Fahad; Khan, Fazal Hameed; Nasir, Muhammad; Ali, Rashid; Iqbal, Ayesha; Raza, Amir

doi:10.7759/cureus.6614

Cited by 5 publications

(3 citation statements)

References 22 publications

(21 reference statements)

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“…Antihypertensive drugs, especially ACEIs and ARBs, can contribute to intraoperative hypotension, especially after general anesthesia induction. 15 , 16 Therefore, patients who were known to use ACEIs and ARBs for preventing deep hypotension were excluded from the study.…”

Section: Discussionmentioning

confidence: 99%

Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Gökduman

Aygün

Canbolat

et al. 2022

Brazilian Journal of Anesthesiology (English Edition)

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Section: Discussionmentioning

confidence: 99%

Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Gökduman

Aygün

Canbolat

et al. 2022

Brazilian Journal of Anesthesiology (English Edition)

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“…For instance, concerns have been raised regarding the continuation of RAS inhibition throughout elective surgery, particularly cardiovascular procedures, with potential hemodynamic instability and hypotension. Indeed, pre-operative discontinuation of ACEi was found to attenuate perioperative decline in blood pressure and the need for pressors, arguing for AKI prevention by pre-operative withholding of RAS blockers, particularly in patients undergoing cardiac surgery [ 13–16 ]. The COVID-19 epidemic invoked an additional unique argument regarding the safety of RAS inhibitors during an acute illness.…”

Section: Introductionmentioning

confidence: 99%

Renal safety and survival among acutely ill hospitalized patients treated by blockers of the Renin-Angiotensin axis or loop diuretics: a single-center retrospective analysis

Assaly,

Gorelik,

Heyman

et al. 2023

Renal Failure

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Background Concern exists regarding the renal safety of blocking the renin-angiotensin system (RAS) during acute illness, especially in the presence of volume depletion and hemodynamic instability. Methods We explored the impact of loop diuretics and RAS blockers on the likelihood of developing acute kidney injury (AKI) or acute kidney functional recovery (AKR) among inpatients. Adjusted odds ratio for AKI, AKR and mortality was calculated, using logistic regression models, with subgroup analysis for patients with estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2, corrected for blood pressure measurements. Results 53,289 patients were included. RAS blockade was associated with reduced adjusted odds ratio for both AKI (0.76, CI 0.70–0.83) AKR (0.55, 0.52–0.58), and mortality within 30 days (0.44, 0.41–0.48), whereas loop diuretics were associated with increased risk of AKI (3.75, 3.42–4.12) and mortality (1.71, 1.58–1.85) and reduced AKR (0.71, 0.66–0.75). Comparable impact of RAS blockers and loop diuretics on renal outcomes and death was found among 6,069 patients with eGFR < 30 ml/min/1.73m 2 . RAS inhibition and diuretics tended to increase the adjusted odds ratios for AKI and to reduce the likelihood of AKR in hypotensive patients. Conclusions Reduced blood pressure, RAS blockers and diuretics affect the odds of developing AKI or AKR among inpatients, suggesting possible disruption in renal functional reserve (RFR). As long as blood pressure is maintained, RAS inhibition seems to be safe and renoprotective in this population, irrespective of kidney function upon admission, and is associated with reduced mortality.

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“…According to the results of primary health research in 2018, hypertension cases in Indonesia reached 26.5%, which was based on direct blood pressure measurement and disease history of the patients [3]. High blood pressure can lead to complications of various deadly diseases Available at www.veterinaryworld.org/Vol.14/January-2021/21.pdf [4]. Hypertension can occur due to unhealthy lifestyle and dietary habits, including the consumption of fast processed foods with high fat, protein, salt, and low-fiber content [5].…”

Section: Introductionmentioning

confidence: 99%

Angiotensin-converting enzyme inhibitor activity of peptides derived from Kacang goat skin collagen through thermolysin hydrolysis

et al. 2021

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Background and Aim: Angiotensin-converting enzyme (ACE) is one of the inhibitory enzymes isolated from animals for the treatment of hypertension. ACE inhibitor (ACE-I) peptides can be obtained by hydrolyzing proteins from various animal tissues, including muscle and connective tissues. However, the study on ACE-I activity from collagen of Kacang goat skin has not been conducted. This study explores the potency of collagen from Kacang goat skin as a source of an antihypertensive agent through ACE inhibition. Thermolysin will hydrolyze collagen and produce the peptide classified antihypertensive bioactive peptides. This study aimed to determine the potential of thermolysin to hydrolyze collagen of Kacang goat skin for ACE-I peptide production and to identify the production of ACE-I peptides. Materials and Methods: Collagen from Kacang goat skin was hydrolyzed with thermolysin and incubated at 37°C for 1 h. Molecular weight (MW) evaluation was performed by SDS PAGE; fractionation peptides at <5 kDa, 3-5 kDa, and <3 kDa were performed by ultrafiltration and ACE-I activity determined by IC50 measurement. Results: Collagen was hydrolyzed by thermolysin, resulting in protein with MW of 117.50-14.60 kDa. The protein content of fractionation at >5 kDa was 3.93±0.72 mg/mL, content of 3-5 kDa was 3.81±0.68 mg/mL, and that of <3 kDa was 2.33±0.38 mg/mL. Fractionation was performed 3 times and one of the results was selected for the ACE-I test. The selected fraction was tested by IC50 measurement with three repetitions and it showed an average enzyme activity at 0.83 μg/mL or 82.94 mg/mL. Conclusion: Thermolysin hydrolysis of collagen from Kacang goat skin showed the potential to produce bioactive peptides, such as ACE-I.

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

Abstract: Open Access Original Article

Cited by 5 publications

References 22 publications

Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Renal safety and survival among acutely ill hospitalized patients treated by blockers of the Renin-Angiotensin axis or loop diuretics: a single-center retrospective analysis

Angiotensin-converting enzyme inhibitor activity of peptides derived from Kacang goat skin collagen through thermolysin hydrolysis

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