Preoperative Inhibition of Angiotensin-Converting Enzyme Improves Systemic and Renal Haemodynamic Changes During Aortic Abdominal Surgery

Licker, Marc-Joseph; Bednarkiewicz, Marek; Neidhart, P.; Tre, R. Pr; Montessuit, Michel; Favre, H; Morel, Denis R.

doi:10.1097/00132586-199706000-00013

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…7 The calculations indicated that, to show a difference greater or equal to 1.2 standard deviation with a power of 90% and a significance of level of 5%, 16 patients should be evaluated in each group.…”

Section: Discussionmentioning

confidence: 99%

Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery

Licker

Schweizer

Hohn

et al. 1999

Can J Anesth/J Can Anesth

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Purpose: Treatment with angiotensin-converting enzyme (ACE) inhibitors affects the autoregulation of renal blood flow and glomerular filtration and provides renal protective effects. The purpose of this case-control study was to investigate the effects of chronic ACE inhibition on perioperative renal hemodynamics and function. Method: We prospectively studied renal function in two groups of patients, chronically treated or not, with ACE inhibitors (ACEI and control; n = 16, in each group) who underwent elective cardiac surgery under hypothermic cardiopulmonary bypass. Glomerular filtration rate, effective renal plasma flow, osmolar clearance and fractional excretion of sodium and potassium were determined before, during and after CPB. Additional measurements included plasma atrial natriuretic factor (ANF) as well as plasma and urinary cyclic GMP (cGMP), thromboxane B 2 (Tx B2) and 6-keto-PGF I. Results: Renal functional and hemodynamic variables did not differ between the two groups, at any period. Cardiopulmonary bypass induced increases in urinary flow, osmolar clearance and fractional excretion of sodium and potassium in both groups. Plasma and urinary ratio of 6-keto-PGFtto Tx B 2 increased markedly and reflected a predominent systemic and renal release of vasodilatory prostaglandins. Intraoperatively, ANF was higher in ACEIs than in control patients. Conclusions: Long term treatment with ACE inhibitors does not influence the perioperative changes in renal hemodynamics and function. During cardiopulmonary bypass, a transient impairment in solute reabsorption is associated with renal release of vasodilatory mediators (nitric oxide and prostacyclin).

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Section: Discussionmentioning

confidence: 99%

Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery

Licker

Schweizer

Hohn

et al. 1999

Can J Anesth/J Can Anesth

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“…Experience suggests that control of blood pressure can be difficult in these patients and there have been reports of low vascular resistance on cardiopulmonary bypass (CPB) [6] in addition to case reports using angiotensin for patients in whom phenylephrine had failed [7]; however, this has been refuted by others [8]. Furthermore, it has been demonstrated that renal function may be preserved in abdominal aortic surgery using ACEIs [9].…”

Section: Introductionmentioning

confidence: 99%

Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors

Bennett

McKeown

Drew

et al. 2001

European J of Heart Fail

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Background: Patients presenting for cardiac surgery are often treated with angiotensin converting enzyme inhibitors Ž . Ž . ACEIs , either for heart failure or hypertension. Control of systemic vascular resistance SVR during surgery can be difficult in such patients. Angiotensin II has been available as an unlicensed vasoconstrictor, but there is concern about renal damage and its use. Aim: This study compared a standard vasoconstrictor with angiotensin II and examined the effect on renal function after cardiac surgery. Method: Twenty consecutive, consenting patients scheduled for cardiac surgery that had been taking ACEIs for at least 6 months, were randomly assigned to receive either phenylephrine or angiotensin II for the control of SVR during and for 24 h after cardiac surgery. A pulmonary artery catheter was used to guide therapy. Creatinine clearance was measured before, 24 and 48 h after surgery. Results: Low SVR and blood pressure requiring intervention was seen in all patients, particularly during cardiopulmonary bypass. One patient in the control group failed to respond to P, but responded normally to angiotensin II. Neither drug caused renal impairment. Conclusion: Angiotensin II is a safe alternative to phenylephrine in patients on ACEIs and should be considered in patients who fail to respond to conventional vasoconstrictors. ᮊ

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“…enalaprilat improves renal perfusion during surgery, and this effect is sustained up to the seventh day after surgery. The doses of enalaprilat used in the present study were expected to suppress circulating levels of angiotensin II: doses of enalaprilat ranging from 10 to 30 mg kg ±1 produce marked inhibition (>90%) of plasma angiotensin-converting enzyme activity for 6 h. 9 In vitro measurements of angiotensin-converting enzyme inhibition or plasma angiotensin II concentration were not done. However, there was indirect but strong evidence of RAS blockade in the ACEI group in the hormonal pro®le found in this study.…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

Ryckwaert

Colson

Ribstein

et al. 2001

British Journal of Anaesthesia

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Renal dysfunction occurring after open heart surgery is multifactorial in origin but activation of the renin-angiotensin system may have a prominent role. Fourteen patients with ischaemic heart dysfunction scheduled for elective coronary artery bypass graft (CABG) surgery were allocated to a treatment group [enalaprilat for 2 days; ACEI (angiotensin-converting enzyme inhibitor) group, n=7] or a control group (n=7). The cardiac index was significantly higher in ACEI-treated patients than in the controls before and after cardiopulmonary bypass (CPB) (P<0.05) and on postoperative day 2 (P<0.05). The systemic vascular resistance was significantly lower in the ACEI-treated patients than in the controls before and after CPB (P<0.05). Renal plasma flow, measured as [131I]orthoiodohippuran clearance (ClH), was higher in the ACEI group than in the control group before CPB, as was endogenous creatinine clearance after CPB (P<0.05). On post-operative day 7, ClH was significantly higher in the ACEI group than in the control group (P<0.05). Plasma renin activity and vasopressin concentration increased in both groups during CPB (P<0.05). The study demonstrates that administration of an i.v. ACEI, enalaprilat, improves cardiac output during CABG surgery in patients with ischaemic heart dysfunction. Moreover, renal perfusion was better maintained during surgery, and this effect was sustained up to post-operative day 7.

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Preoperative Inhibition of Angiotensin-Converting Enzyme Improves Systemic and Renal Haemodynamic Changes During Aortic Abdominal Surgery

Cited by 5 publications

References 10 publications

Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery

Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery

Angiotensin in cardiac surgery: efficacy in patients on angiotensin converting enzyme inhibitors

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

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