Long-term Angiotensin-converting Enzyme Inhibitor Treatment Attenuates Adrenergic Responsiveness without Altering Hemodynamic Control in Patients Undergoing Cardiac Surgery

Licker, Marc; Neidhart, P.; Lustenberger, S.; Valloton, Michael B.; Kalonji, Tshibambula; Fathi, Marc; Morel, Denis R.

doi:10.1097/00000542-199604000-00005

Cited by 102 publications

(27 citation statements)

References 41 publications

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“…In addition, chronic AT 1 blockade also reduces the vasoconstrictor response to α 1 receptors activated by norepinephrine, which explains why ARB-induced hypotension can be so resistant to phenylephrine, ephedrine and norepinephrine 2, 8 as observed in our patient. The lack of response to repeated phenylephrine boluses and a continuous infusion, fluids and a decrease of the volatile anesthetic urgently required a different approach, and we administered vasopressin in repeated boluses.…”

Section: Discussionsupporting

confidence: 57%

Case Report: Refractory hypotension during general anesthesia despite preoperative discontinuation of an angiotensin receptor blocker

2013

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Due to their beneficial reduction in morbidity and mortality angiotensin receptor blockers (ARBs) have become increasingly popular to treat hypertension. However, similar to angiotensin converting enzyme inhibitors, they can lead to severe hypotension in conjunction with general anesthesia and thus have been recommended to be withheld in the morning of surgery. Here, we present a 51 year old female who developed severe refractory hypotension after induction of general anesthesia, although she had discontinued her medication 24 hours preoperatively as instructed. Therefore, halting ARBs for more than 24 hours before surgery may be necessary. Heightened awareness of this potential interaction and recognizing the need to treat with vasopressin is required when ARB-induced hypotension occurs.

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Section: Discussionsupporting

confidence: 57%

Case Report: Refractory hypotension during general anesthesia despite preoperative discontinuation of an angiotensin receptor blocker

2013

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“…During CPB, MAP was reduced in BB and ACEI groups compared with the post-sternotomy period according to the loss of the cardiac contribution and probably to the alterations of the sympathetic nervous system induced by the treatments [28,29]. Lowering MAP by BB could be explained by various hypotheses such as an action within the central nervous system, a peripheral inhibition of sympathetic nervous activity, and a stimulation of vasodilator prostaglandins.…”

Section: Cpb Periodmentioning

confidence: 99%

Blood pressure and heart rate variability changes during cardiac surgery with cardiopulmonary bypass

Neto¹,

Loufouat²,

Saroul³

et al. 2004

Fundamemntal Clinical Pharma

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This study investigated patients undergoing elective cardiac surgery to evaluate the effects of cardiopulmonary bypass (CPB) on the spontaneous variability of mean arterial pressure (MAP) and heart rate (HR). Forty-one adult patients receiving different cardiovascular system drugs were included in the study. Patients were divided into three groups: no preoperative pharmacological cardiovascular treatment (n = 12), beta-blocker (BB) (n = 13), and angiotensin-converting enzyme inhibition (ACEI) (n = 16). MAP was recorded before anaesthesia until the end of surgery. MAP and HR variability was analysed in very low- (VLF), low- (LF) and high-frequency bands. The LF spectral component of MAP was observed to decrease in patients under ACEI (-92%) or BB (-87%) following induction of anaesthesia. In addition, during CPB, VLF power decreased in BB group (-67%), and LF power decreased in ACEI group (-77%). Concerning HR, VLF spectral power decreased following anaesthesia in BB group (-74%). In addition, after CPB, VLF power reached lower value in ACEI group than in BB group (P < 0.05). LF spectral power of HR showed a large decrease after CPB in ACEI group (-89%). This study showed that MAP variability did not change during CPB in patients with no preoperative pharmacological cardiovascular treatment, suggesting an unaltered vascular control of MAP. Moreover, the change in LF spectral power of MAP in ACEI and BB groups, suggests that both the renin-angiotensin and sympathetic systems participate to the genesis of LF variability of MAP.

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“…In people, intraoperative hypotension (Colson et al 1999;Bertrand et al 2001;Comfere et al 2005;Miceli et al 2009;Auron et al 2011) and functional acute kidney injury (Coca et al 2013) are more common in patients receiving RAAS antagonists on the day of surgery and these individuals may be refractory to standard interventions for hypotension during the anesthetic period (Licker et al 1996;Brabant et al 1999a,b;Meersschaert et al 2002). However, there are currently no consensus guidelines in human medicine that support the continuation or withdrawal of these drugs in the perioperative period.…”

Section: Introductionmentioning

confidence: 99%

Effects of orally administered enalapril on blood pressure and hemodynamic response to vasopressors during isoflurane anesthesia in healthy dogs

Coleman

Shepard²,

Schmiedt

et al. 2016

Veterinary Anaesthesia and Analgesia

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Long-term Angiotensin-converting Enzyme Inhibitor Treatment Attenuates Adrenergic Responsiveness without Altering Hemodynamic Control in Patients Undergoing Cardiac Surgery

Cited by 102 publications

References 41 publications

Case Report: Refractory hypotension during general anesthesia despite preoperative discontinuation of an angiotensin receptor blocker

Case Report: Refractory hypotension during general anesthesia despite preoperative discontinuation of an angiotensin receptor blocker

Blood pressure and heart rate variability changes during cardiac surgery with cardiopulmonary bypass

Effects of orally administered enalapril on blood pressure and hemodynamic response to vasopressors during isoflurane anesthesia in healthy dogs

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