Role of Renin-Angiotensin System Inhibitors in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Kinoshita, Takeshi; Asai, Tomohiro

doi:10.1253/circj.cj-10-0704

Cited by 1 publication

(2 citation statements)

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“…There was no significant difference in mean arterial pressure between two groups and entirely no patient needed vasoactive agents during weaning from CPB and rewarming. This finding correlates with Kinoshita᾿ study, which explained that preoperative enalapril administration did not cause any hemodynamic changes during surgery (15). Our results did not correlate with Devbhandari᾿s investigation in which the mean arterial pressure was higher in the group who received ACEIs.…”

Section: Discussionsupporting

confidence: 90%

“…However, if severe vasodilation due to chronic consumption of ACEIs and ARAs occurs during CPB, the weaning process will not be probable and high dose vasopressors will be needed (14). Some investigations have reported diminishing ischemic events, myocardial infarction, renal failure, and mortality rate by ACEIs and ARAs administration (11, 15, 16). Due to these contrary findings about ACEIs and ARAs, the aim of our study was to determine the effect of chronic consumption of ACEIs and ARAs on blood pressure and inotrope consumption after separation from cardiopulmonary bypass (17, 18).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Chronic Consumption of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Antagonists on Blood Pressure and Inotrope Consumption After Separation from Cardiopulmonary Bypass

et al. 2018

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BackgroundChronic use of renin-angiotensin system (RAS) antagonists (angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor antagonists (ARAS)) can cause hypotension during anesthesia. In some studies hemodynamic instability, including hypotension and its effects on the clinical outcome in patients treated with these drugs during coronary artery bypass graft (CABG) and need to excessive vasoactive drugs in these patient population, has been described. The aim of this study was to evaluate the effect of chronic consumption of ACEIs and ARAS on blood pressure and inotrope consumption during coronary artery bypass graft under cardiopulmonary bypass.MethodsA total of 200 patients undergoing coronary artery bypass graft surgery, who were treated with either ARAS or ACEIs (n = 100) over at least 2 months, or who were not treated with any RAS antagonists (control group, n = 100) were enrolled. The mean arterial blood pressure, central venous pressure, and need for vasoactive drugs, were measured after induction of anesthesia (T1) before cardiopulmonary bypass (T2) and after separation from (CPB), (T3).ResultsThere were no significant differences regarding the mean arterial pressure (case group: T1: 84 ± 7 mmHg, T2: 77 ± 6 mmHg, T3: 83 ± 8 mmHg), (control group: T1: 85 ± 7 mmHg, T2: 81 ± 7 mmHg, T3:84 ± 6 mmHg) between two groups (P > 0.05). Also there were no significant differences regarding mean central venous pressure, mean heart rate, and vasoactive drug consumption between the two groups during the time of intervals.ConclusionsWe found that preoperative (RAS) antagonist’s continuation have not profound hemodynamic changes during coronary artery bypass graft under cardiopulmonary bypass and so we conclude that omitting these drugs before surgery did not have a sufficient advantage to be recommended routinely.

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Section: Discussionsupporting

confidence: 90%