Zur perioperativen Gabe von ACE-Hemmern

Schirmer, Uwe; Schürmann, Wolfgang

doi:10.1007/s00101-007-1177-x

Cited by 39 publications

(6 citation statements)

References 25 publications

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“…The safety of prescribing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the day of surgery is unclear. In a pooled analysis of 3 small randomized trials including 188 participants, perioperative continuation of ACEIs or ARBs was associated with increased rates of intraoperative hypotension (57.8% vs 23.5% in those who discontinued use of ACEIs or ARBs; pooled relative risk, 2.53 [95% CI, 1.08-5.93]) . In a large observational study of 4802 individuals undergoing noncardiac surgery, perioperative discontinuation of ACEIs or ARBs prior to surgery was associated with a lower risk of perioperative hypotension (23.3% vs 28.6% in those with continued use of ACEIs or ARBs; adjusted relative risk, 0.80 [95% CI, 0.73-0.88]) and with a lower risk of the composite end point of myocardial injury after noncardiac surgery, stroke, and mortality at 30 days (12.0% vs 12.9%, respectively; adjusted relative risk, 0.82 [95% CI, 0.70-0.96]) …”

Section: Methodsmentioning

confidence: 99%

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Smilowitz

Berger

2020

JAMA

189

140

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IMPORTANCEPerioperative cardiovascular complications occur in 3% of hospitalizations for noncardiac surgery in the US. This review summarizes evidence regarding cardiovascular risk assessment prior to noncardiac surgery.OBSERVATIONS Preoperative cardiovascular risk assessment requires a focused history and physical examination to identify signs and symptoms of ischemic heart disease, heart failure, and severe valvular disease. Risk calculators, such as the Revised Cardiac Risk Index, identify individuals with low risk (<1%) and higher risk (Ն1%) for perioperative major adverse cardiovascular events during the surgical hospital admission or within 30 days of surgery. Cardiovascular testing is rarely indicated in patients at low risk for major adverse cardiovascular events. Stress testing may be considered in patients at higher risk (determined by the inability to climb Ն2 flights of stairs, which is <4 metabolic equivalent tasks) if the results from the testing would change the perioperative medical, anesthesia, or surgical approaches. Routine coronary revascularization does not reduce perioperative risk and should not be performed without specific indications independent of planned surgery. Routine perioperative use of low-dose aspirin (100 mg/d) does not decrease cardiovascular events but does increase surgical bleeding. Statins are associated with fewer postoperative cardiovascular complications and lower mortality (1.8% vs 2.3% without statin use; P < .001) in observational studies, and should be considered preoperatively in patients with atherosclerotic cardiovascular disease undergoing vascular surgery. High-dose β-blockers (eg, 100 mg of metoprolol succinate) administered 2 to 4 hours prior to surgery are associated with a higher risk of stroke (1.0% vs 0.5% without β-blocker use; P = .005) and mortality (3.1% vs 2.3% without β-blocker use; P = .03) and should not be routinely used. There is a greater risk of perioperative myocardial infarction and major adverse cardiovascular events in adults aged 75 years or older (9.5% vs 4.8% for younger adults; P < .001) and in patients with coronary stents (8.9% vs 1.5% for those without stents; P < .001) and these patients warrant careful preoperative consideration.CONCLUSIONS AND RELEVANCE Comprehensive history, physical examination, and assessment of functional capacity during daily life should be performed prior to noncardiac surgery to assess cardiovascular risk. Cardiovascular testing is rarely indicated in patients with a low risk of major adverse cardiovascular events, but may be useful in patients with poor functional capacity (<4 metabolic equivalent tasks) undergoing high-risk surgery if test results would change therapy independent of the planned surgery. Perioperative medical therapy should be prescribed based on patient-specific risk.

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Section: Methodsmentioning

confidence: 99%

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Smilowitz

Berger

2020

JAMA

189

140

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“…Of the 77 patients who did develop hypotension in our study, 41 patients needed the use of vasopressors to correct the hypotension. This can be compared to the double-blinded, randomized control study done by Schirman and Schurman on 100 patients who said that the patients who received ACE inhibitors had to be given vasopressor support more often (17 of the 50 patients ) than patients who didn't receive the drug (5 out of 50 patients) but still developed hypotension [19].…”

Section: Discussionmentioning

confidence: 99%

Frequency of Intraoperative Hypotension After the Induction of Anesthesia in Hypertensive Patients with Preoperative Angiotensin-converting Enzyme Inhibitors

Salim

Khan

Nasir

et al. 2020

Cureus

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“…[567891011] In the present study, we defined hypotension as SBP ≤85 mmHg, based on the previous study by Comfere et al . [6] However, the patient safety was not compromised as hypotension lasting for >1 min and/or MAP <60 mmHg was promptly treated.…”

Section: Discussionmentioning

confidence: 99%

Effect of pre-operative discontinuation of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists on intra-operative arterial pressures after induction of general anesthesia

et al. 2014

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Context:Medical guidelines advise perioperative continuation many antihypertensives, but discontinuing angiotensin antagonists before surgery.Aims:This study is aimed to determine the effect of preoperative discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA) on intra-operative blood pressure after induction of general anesthesia.Settings and Design:The study was a randomized, prospective and double blinded one done in 60 hypertensive patients, receiving these drugs.Materials and Methods:Patients were randomized into two equal groups. In Group A, ACEI or angiotensin II receptor antagonist was stopped the day before surgery, but in Group B it was continued. Anesthetic management was standardized by a study protocol. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured just before induction and after induction at 1 min, 3, 5, 10, 15, 30, 45 and 60 min.Statistical Analysis:Difference between means and difference between two proportions was analyzed using Normal test for means and corresponding P values were calculated.Results:Pre-induction SBP, DBP and MAP were comparable between groups. However when the pre-induction values were compared with subsequent readings at 3, 5, 10, 15, 30, 45 and 60 min, it was found that there was a significant reduction in SBP, DBP and MAP in Group B up to 60 min.Conclusions:Intraoperative hemodynamics can be safely managed when ACEI or ARA are withheld on the day of surgery.

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Zur perioperativen Gabe von ACE-Hemmern

Cited by 39 publications

References 25 publications

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery

Frequency of Intraoperative Hypotension After the Induction of Anesthesia in Hypertensive Patients with Preoperative Angiotensin-converting Enzyme Inhibitors

Effect of pre-operative discontinuation of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists on intra-operative arterial pressures after induction of general anesthesia

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