Influence of Chronic Angiotensin-converting Enzyme Inhibition on Anesthetic Induction

Coriat, Pierre; Richer, Christine; Douraki, Tomais; Gómez, Carlos Miguel Osorio; Hendricks, Karl; Giudicelli, Jean‐François; Viars, P.

doi:10.1097/00000542-199408000-00006

Cited by 296 publications

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“…Indeed, most hypotensive events can be prevented either by stopping the ACEI 24-48 hr before surgery or, -instead of giving a fixed dose regimen -, by titrating and reducing the anesthetic dosage according to the hemodynamic effects. 4,6,32 As already reported by Schwinn et al, 3 3 the vasopressor response to PHE was greater during anesthesia than in the awake period in patients with an intact renin angiotensin system. Altogether these data suggest that anesthetic-induced relaxation of peripheral vasomotor tone unmasked the positive interaction between the vasoconstrictive effects of angiotensin II and PHE.…”

Section: Anesthesia-induced Hypotensionsupporting

confidence: 59%

“…Some of these patients are prone to develop hypotensive episodes during anesthesia induction and weaning from cardiopulmonary bypass. 4,5 Adrenergic receptor hyporesponsiveness and regression of cardiovascular hypertrophy are thought to be implicated in such impaired hemodynamic control. 6 Although ACEIs are capable of reducing sympathetic drive and augmenting vagal tone in awake subjects, 7 it is unknown whether such alterations in baroreflex function and sympathovagal balance also occur during anesthesia which could be incriminated in hypotensive events.…”

Section: Resultsmentioning

confidence: 99%

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Cardiovascular responses to anesthetic induction in patients chronically treated with angiotensin-converting enzyme inhibitors

Licker¹,

Schweizer²,

Hohn³

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To investigate the effects of chronic ACE inhibition on cardiac neural function following induction of general anesthesia in patients with underlying coronary artery disease. Method:In a prospective case-control study, heart rate variability (HRV) and baroreflex control were compared preoperatively and 30 min after anesthesia induction in patients receiving, or not, ACEI (n=16, control group and n=16, ACEI group). All patients had normal cardiac function and anesthesia consisted of a fixed dose regimen of fentanyl and midazolam. Anesthesia-related hypotension was defined by systolic blood pressure < 90 mmHg. Spectral density of HRV was calculated for low frequency and high frequency bands (LF, from 0.05 to 0.15 Hz and HF, from > 0.15 to 0.6 Hz). Baroreflex sensitivity was estimated after blood pressure changes induced by injections of phenylephrine (PHE) and nitroglycerin (NTG). Results:The HRV parameters and baroreflex sensitivity were not different between groups, during the awake and anesthesia periods. Anesthesia produced similar reduction in total HRV in the Control and ACEI groups (-93 ± 28% vs -89 ± 32%,) and in baroreflex sensitivity during NTG (-64 ± 21% vs -54 ± 17%) or PHE tests (-74 ± 25% vs -72 ± 22%). Anesthesia-related hypotension occurred in nine patients in the ACEI group (vs two controls). Although the hypertensive response to phenylephrine was greater after anesthesia in both groups, the sensitivity to phenylephrine was attenuated in those patients experiencing hypotension in the ACEI group. Conclusions: Chronic preoperative treatment with ACEIs does not influence cardiac autonomic regulation and anesthetic-induced hypotensive episodes are mainly attributed to decreased -adrenergic vasoconstrictive response.Objectif : Rechercher les effets d'une inhibition chronique de l'ECA sur la fonction neurale cardiaque à la suite de l'induction d'une anesthésie générale chez des patients qui présentent une cardiopathie ischémique sous-jacente.Méthode : Lors d'une étude prospective cas-témoins, la variabilité de la fréquence cardiaque (VFC) et le contrôle baroréflexe ont été comparés avant l'opération et 30 min après l'induction de l'anesthésie chez des patients qui reçoivent, ou non, un IECA (groupe témoin : n = 16, groupe IECA : n = 16). Tous les patients présentaient une fonction cardiaque normale et l'anesthésie comprenait un schéma posologique fixe de fentanyl et de midazolam. On a défini l'hypotension reliée à l'anesthésie comme la tension artérielle systolique < 90 mmHg. La densité spectrale de la VFC a été calculée pour des bandes de basses et de hautes fréquences (BF, de 0,05 à 0,15 Hz et HF, de > 0,15 à 0,6 Hz). La sensibilité baroréflexe a été évaluée après les changements de pression sanguine induits par les injections de phényléphrine (PHE) et de nitroglycérine (NTG).Résultats : Les paramètres de la VFC et la sensibilité baroréflexe n'ont pas présenté de différence intergroupe pendant les périodes d'éveil et d'anesthésie. L'anesthésie a produit une réduction similaire de la VFC total...

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Section: Anesthesia-induced Hypotensionsupporting

confidence: 59%

Section: Resultsmentioning

confidence: 99%

Cardiovascular responses to anesthetic induction in patients chronically treated with angiotensin-converting enzyme inhibitors

Licker¹,

Schweizer²,

Hohn³

et al. 2000

Can J Anesth/J Can Anesth

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“…Only 1 study specified the extent of loss to followup. 8 In 1 of the observational studies, 9 details of cohort selection were generally appropriate. The 12 patients examined in another study 10 had been scheduled consecutively for surgery.…”

Section: Search Resultsmentioning

confidence: 99%

Clinical consequences of withholding versus administering renin‐angiotensin‐aldosterone system antagonists in the preoperative period

Rosenman

McDonald

Ebbert

et al. 2008

Journal of Hospital Medicine

137

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BACKGROUND:Hospitalists involved in perioperative care either stop or continue until the day of surgery renin‐angiotensin‐aldosterone system antagonists (either angiotensin‐converting enzyme inhibitors [ACEI] or angiotensin II receptor subtype 1 antagonists [ARA]) in patients who use these agents chronically. This practice variation reflects uncertainty regarding the risks and benefits of either approach.PURPOSE:The purpose of this study was to assess the clinical consequences of preoperatively continuing versus withholding ACEI/ARAs in patients treated chronically with these agents.DATA SOURCES AND STUDY SELECTION:We comprehensively searched 7 major electronic databases, considered references from selected reviews, hand‐searched journals, and communicated with experts. We included randomized trials and observational studies.DATA EXTRACTION:We evaluated the relative risk (RR) of hypotension requiring vasopressors and of myocardial infarction in patients who did or did not receive an immediate preoperative dose of ACEI or ARA.DATA SYNTHESIS:Random‐effects meta‐analysis from 5 studies totaling 434 patients suggested that patients receiving an immediate preoperative ACEI/ARA dose were more likely (RR 1.50, 95% CI 1.15‐1.96) to develop hypotension requiring vasopressors at or shortly after induction of anesthesia. Sufficient data were not available to assess other outcomes.CONCLUSIONS:Preoperative administration of ACEI/ARAs increases intraoperative hypotension. The long‐term clinical consequences of continuing versus withholding preoperative ACEI/ARAs are unknown. This uncertainty stems in part from the absence to date of randomized trials designed specifically to examine patient‐important consequences of this decision. Journal of Hospital Medicine 2008;3:319–325. © 2008 Society of Hospital Medicine.

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“…31 There has been a concern expressed in the literature about the perioperative use of ACE inhibitors due to the potential for intraoperative hypotension. [32][33][34][35][36] Many centers advise patients to discontinue ACE inhibitor use the day before surgery. The number of patients studied remains small.…”

Section: Discussionmentioning

confidence: 99%

Impact of combination medical therapy on mortality in vascular surgery patients

Barrett

Newton

Koudelka

et al. 2010

Journal of Hospital Medicine

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Influence of Chronic Angiotensin-converting Enzyme Inhibition on Anesthetic Induction

Cited by 296 publications

References 0 publications

Cardiovascular responses to anesthetic induction in patients chronically treated with angiotensin-converting enzyme inhibitors

Cardiovascular responses to anesthetic induction in patients chronically treated with angiotensin-converting enzyme inhibitors

Clinical consequences of withholding versus administering renin‐angiotensin‐aldosterone system antagonists in the preoperative period

Impact of combination medical therapy on mortality in vascular surgery patients

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