Aliskiren: A New Harbinger of Hypotension?

Abstract

<div style="text-align:justify;"> <span style="line-height:1.5;">We present a case of significant, persistent, and relatively refractory hypotension during general anesthesia in a reasonably healthy 50-year-old man thought to be caused by a direct rennin inhibitor. This case is of particular significance because the medication thought responsible for the hemodynamic abnormalities is a relatively novel antihypertensive agent and remains largely unknown to clinical anesthesia providers.</span> </div

Anesthetic Management of the Hypertensive Patient: Part I

“…It is well known that ACEIs and ARBs are associated with refractory hypotension during induction of general anesthesia, and it can be assumed that direct renin inhibitors, which act earlier on the same pathway and produce similar if not more exaggerated downstream effects, would have similar anesthetic implications. 42 If the standard treatment for postinduction hypotension, such as a fluid bolus, ephedrine, or phenylephrine administrations, is ineffec-tive, then an infusion of vasopressin (0.03-1 U/min) or methylene blue (2 mg/kg over 20 minutes) can be given with documented success. 43 Aliskiren has also been associated with an increased incidence of nonfatal stroke, renal complications, and hyperkalemia.…”