Effect of Angiotensin Converting Enzyme Inhibition on Blood Pressure and Renal Function during Open Heart Surgery

Colson, P; Ribstein, Jean; Mimran, A; D, Grolleau; Chaptal, P.A.; Roquefeuil, B

doi:10.1097/00000542-199001000-00005

Cited by 94 publications

(33 citation statements)

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“…Regarding intraoperative hypotension and its repercussion in other organ systems, some authors have recommended continuation of the treatment with ACE inhibitors for several reasons. Some authors suggest that the uninterrupted use of those drugs can be associated with a reduction in myocardial ischemia in cardiac surgeries 13 . On the other hand, other authors observed that, during cardiopulmonary bypass, the effective renal flow and glomerular filtration rate remain unchanged, while sodium excretion was greater in patients who received captopril when compared with patients who received placebo 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Some authors suggest that the uninterrupted use of those drugs can be associated with a reduction in myocardial ischemia in cardiac surgeries 13 . On the other hand, other authors observed that, during cardiopulmonary bypass, the effective renal flow and glomerular filtration rate remain unchanged, while sodium excretion was greater in patients who received captopril when compared with patients who received placebo 13 . Others argue that not one single study assessed the potential level of protection of maintaining the treatment with ACE inhibitors in patients at high risk for the development of renal failure 11 .…”

Section: Discussionmentioning

confidence: 99%

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Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório?

Costa¹,

Caldas²,

Nunes³

et al. 2009

Rev. Bras. Anestesiol.

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COSTA, CALDAS, NUNES ET AL. commended 7 . In contrast, the discontinuation of drugs, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) on the day of the surgery based on reports of significant hypotension after induction of anesthesia suggesting a deleterious interaction between ACE inhibitors and anesthetics in general has been questioned or suggested by some authors 8,9 . However, discontinuation of drugs used for a long time, such as antihypertensives, can implicate on a higher risk of intraoperative hypertensive peaks with harmful consequences for the patient 7 . This has generated controversies among anesthesiologists and, occasionally, conflicts with the physician in charge. The objective of this preliminary study was to evaluate the influence of the preoperative use of ACE inhibitors on the incidence of clinically significant hypotension (hypotension requiring intervention by the anesthesiologist) after anesthetic induction. METHODSAfter approval by the Ethics Committee of the hospital, a case-control, retrospective study in which the study group was composed by all patients who presented significant hypotension after anesthetic induction during the study period, i.e., one year, was undertaken. Cases of hypotension that required intervention such a volume expansion and use of vasopressors by the anesthesiologist responsible for the case were considered significant. Patients underwent orthopedic, neurosurgical, reconstructive plastic surgery, urologic, and thoracic procedures. Electronic medical records were reviewed for data on anesthetic induction, the moment the patient developed hypotension, therapeutic measures, and evolution of the case. The control group was composed by four patients, randomly selected, for each study patient, to increase the power of the statistical analysis 10 . Patients in the control group were in the same age range, underwent the same type of surgery and at the same time as the study patients, and did not develop hypotension after anesthetic induction. Patients younger than 18 years and those who received local anesthetics or sedation as the only technique were excluded from the study. Parameters analyzed were as follows: age, gender, size of the surgery, prior diagnosis of hypertension, use of ACE inhibitors, physical status (ASA), intraoperative bleeding, anesthetic technique, and duration of the surgery. Analysis of Variance was used for numerical parameters and Fisher's Exact test for categorical parameters. For categorical parameters with significant association, the degree of increase in risk was determined by odds ratio. Univariate and multiple analyses were also undertaken using logistic regressions. Data were processed by SPSS for Windows, version 13.0.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório?

Costa¹,

Caldas²,

Nunes³

et al. 2009

Rev. Bras. Anestesiol.

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“…Several small randomized clinical trials (n¼14-40) provide evidence that perioperative ACE inhibitor therapy improved renal blood flow and/or function in patients undergoing cardiac surgery. [55][56][57] In the postoperative intensive care unit, Wagner et al investigated the effects of enalaprilat on cardiac and renal function in patients (n¼40) with a left ventricular ejection fraction o35% following CABG. The results showed that intravenous enalaprilat increased creatinine clearance and decreased serum creatinine and urea.…”

Section: )mentioning

confidence: 99%

ACE inhibitors in cardiac surgery: current studies and controversies

2010

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Major complications associated with cardiac surgery are still common and carry great prognostic significance. Current medical interventions to prevent these cardiovascular complications include antiplatelet therapy, statins, b-blockers and angiotensinconverting enzyme (ACE) inhibitors. Both experimental studies and clinical trials have shown that ACE inhibitors hold promise as cardiovascular protective agents for cardiac surgery patients. Several lines of evidence support this hypothesis. First, long-term use of ACE inhibitors has been well established to provide cardiovascular protection and reduce ischemic events and complications, independent of their effect on heart function and blood pressure. Second, early ACE inhibitor therapy has been demonstrated to produce remarkable survival and heart function benefits in patients with acute myocardial infarction. Third, ACE blockage can prevent or delay the development or progression of renal disease at all stages, from subclinical microalbuminuria to end-stage renal disease. Nevertheless, perioperative studies of the effects of ACE inhibitors remain few and inconclusive. Results from recent clinical trials and observational studies are conflicting and raise more questions than answers. Further studies, both retrospective and larger-scale prospective studies, are critically needed to examine whether ACE inhibitors reduce mortality and major complications in patients undergoing cardiac surgery.

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“…19 Studies have found that the patients receiving even shortterm (2 d) RAS inhibitors prior to CABG surgery had improved cardiac and renal functions following cardiac surgery. [20][21][22][23] In a study of 536 patients, the pre-op ACEi was associated with a decreased incidence of postoperative AKI (OR: 0.48, 95% CI: 0.23-0.77, p ¼ 0.04) after on-pump CABG surgery.…”

mentioning

confidence: 99%

The Effects of Preoperative Renin-Angiotensin System Inhibitors on Outcomes in Patients Undergoing Cardiac Surgery

Shi

Young

et al. 2013

Journal of Cardiothoracic and Vascular Anesthesia

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Effect of Angiotensin Converting Enzyme Inhibition on Blood Pressure and Renal Function during Open Heart Surgery

Cited by 94 publications

References 0 publications

Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório?

Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório?

ACE inhibitors in cardiac surgery: current studies and controversies

The Effects of Preoperative Renin-Angiotensin System Inhibitors on Outcomes in Patients Undergoing Cardiac Surgery

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