Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Sahai, Sunil K.; Balonov, Konstantin; Bentov, Nathalie; Bierle, Dennis M.; Browning, Lorinda M.; Cummings, Kenneth C.; Dougan, Brian; Maxwell, Megan; Merli, Geno J.; Oprea, Adriana D.; Sweitzer, BobbieJean; Mauck, Karen F.; Urman, Richard D.

doi:10.1016/j.mayocp.2022.03.039

Cited by 9 publications

(2 citation statements)

References 86 publications

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“…In perioperative settings with anesthesia, fluid shifts, and blood loss, the maintenance of ACE inhibitors has been linked to an increased risk of arterial hypotension and acute kidney injury (AKI) ( Kellow, 1994 ; Roshanov et al, 2017 ; Hollmann et al, 2018 ). Consequently, withholding ACE inhibitors for 24 h before surgery is generally recommended to prevent persistent hypotension, especially in patients treated for arterial hypertension ( Sousa-Uva et al, 2018 ; Sahai et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Guilleminot,

Andrei,

Nguyen

et al. 2024

Front. Pharmacol.

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Objective: We investigated the effects of the maintenance of angiotensin-converting enzyme inhibitors (ACE inhibitors) the day of the surgery on the incidence of postoperative acute kidney injury (AKI) and cardiac events in patients undergoing cardiac surgery.Methods: We performed a multicentric observational study with propensity matching on 1,072 patients treated with ACE inhibitors. We collected their baseline demographic data, comorbidities, and operative and postoperative outcomes. AKI was defined by KDIGO (Kidney Disease: Improving Global Outcome).Results: Maintenance of an ACE inhibitor was not associated with an increased risk of AKI (OR: 1.215 (CI95%:0.657–2.24), p = 0.843, 71 patients (25.1%) vs. 68 patients (24%)). Multivariate logistic regression and sensitive analysis did not demonstrate any association between ACE inhibitor maintenance and AKI, following cardiac surgery (OR: 1.03 (CI95%:0.81–1.3)). No statistically significant difference occurs in terms of incidence of cardiogenic shock (OR: 1.315 (CI95%:0.620–2.786)), stroke (OR: 3.313 (CI95%:0.356–27.523)), vasoplegia (OR: 0.741 (CI95%:0.419–1.319)), postoperative atrial fibrillation (OR: 1.710 (CI95%:0.936–3.122)), or mortality (OR: 2.989 (CI95%:0.343–26.034)). ICU and hospital length of stays did not differ (3 [2; 5] vs. 3 [2; 5] days, p = 0.963 and 9.5 [8; 12] vs. 10 [8; 14] days, p = 0.638).Conclusion: Our study revealed that maintenance of ACE inhibitors on the day of the surgery was not associated with increased postoperative AKI. ACE inhibitor maintenance was also not associated with an increased rate of postoperative major cardiovascular events (arterial hypotension, cardiogenic shock, vasopressors use, stroke and death).

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Section: Introductionmentioning

confidence: 99%

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Guilleminot,

Andrei,

Nguyen

et al. 2024

Front. Pharmacol.

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show abstract

“…The safe and effective management of the perioperative period for such patients requires continuous update in medical knowledge, familiarity with recent advances in pharmacotherapy, and drug delivery methods. The perioperative clinician must consult various sources, from expert consensus statements to randomized studies, to make informed recommendations for preoperative medication management ( Sahai et al, 2022 ).…”

mentioning

confidence: 99%

Editorial: New trends and approaches in perioperative pharmacotherapy, volume III

Soghomonyan,

Bergese,

Stoicea

2024

Front. Pharmacol.

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Practice Changing Updates in Perioperative Medicine Literature 2022. A Systematic Review

Khambaty

Devalapalli

Silbert

et al. 2023

The American Journal of Medicine

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Preoperative Management of Cardiovascular Medications: A Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Cited by 9 publications

References 86 publications

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Editorial: New trends and approaches in perioperative pharmacotherapy, volume III

Practice Changing Updates in Perioperative Medicine Literature 2022. A Systematic Review

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