The renin‐angiotensin system and angiotensin convertin enzyme (ACE) inhibitors.

Kellow, N.

doi:10.1111/j.1365-2044.1994.tb14234.x

Cited by 18 publications

(1 citation statement)

References 81 publications

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“…The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia), 1997 ; Coca, 2020 ). 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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Angiotensin-Converting Enzyme Inhibitor Fetopathy

Barr¹

1997

Drug Toxicity in Embryonic Development II

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Discontinuing drugs before surgery

Doak

1997

Can J Anaesth

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A anaesthesia NAESTHETISTS are increasingly confronted with surgical patients with complex medical problems, often treated with a myriad of drugs. Administration of safe and effective requires an understanding of patient pathophysiology and the pharmacology of potential drug interactions. One strategy of risk management in such patients is to reduce the potential for adverse interactions by discontinuing selected drugs before surgery. The objective of this review is to provide insight into the practice of discontinuing drugs before surgery, with particular reference to those classes of drugs for which this practice has been advocated or is controversial. General considerationsIt is assumed that maintenance drug therapy has been prescribed for a patient to treat a specific condition and that this treatment has been optimized and that the condition is relatively stable. Experience has shown that, for the most part, in the perioperative period this stability is best maintained by continuation of these medications uninterrupted wherever possible.When it is deemed necessary to withhold medication preoperatively, the anaesthetist must consider the pharmacokinetic profile of the drug to ensure sufficient time is allowed for metabolic clearance. Ideally this is three to five half-lives. This may be complicated by the presence of active metabolites. Oral medications and NPO statusHistorically, it has been the practice to fast adult patients, for six hours or longer prior to surgery, to reduce the risk of pulmonary aspiration of gastric contents. Nulla per os (NPO) often included oral medications (inadvertently or by design). Critical examination has resulted in a relaxation of this policy and it would seem that most anaesthetists normally allow dear fluids up to two to three hours preoperatively in patients with a functioning gastrointestinal tract. ~-3 Therefore, NPO status per se should not be considered a valid reason for discontinuing maintenance drug therapy preoperatively. For patients whose gastrointestinal tract is non-functioning, consideration to alternative drugs or routes of delivery should be considered.Drugs affecting the cardiovascular system Concern about the body's response to anaesthetic drugs, shifts in intravascular volume, and manipulations of the sympathetic nervous system in the presence of drugs affecting the cardiovascular system, has given way to evidence of the benefits of uninterrupted antihypertensive and antianginal therapy in the perioperative period. In particular, withdrawal syndromes associated with abrupt cessation of fl-blockers and ~2-agonists are avoided, but also the risk of manifestation of underlying hypertension or myocardial ischaemia in the perioperafive period is lessened by the continued administration of most antihypertensive and antianginal agents. Renin-angiotensin system (RAS) inhibitorsThe RAS is a homeostatic mechanism for blood pressure control that is activated in response to a perceived reduction in effective circulating volume. The result is a biochemical cascade cu...

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The renin‐angiotensin system and angiotensin convertin enzyme (ACE) inhibitors.

Abstract: Summary Anaesthetists will encounter increasing numbers of patients who are receiving lorig-term treatment with A C E inhibitors

Cited by 18 publications

References 81 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

Angiotensin-Converting Enzyme Inhibitor Fetopathy

Discontinuing drugs before surgery

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