Related Experiment Videos
Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive
D W Pigott1, C Nagle, K Allman
1Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headington, Oxford, UK.
Insights
Omitting angiotensin converting enzyme (ACE) inhibitors before coronary artery bypass graft (CABG) surgery did not improve cardiovascular stability. While reducing vasopressor needs during cardiopulmonary bypass, it increased vasodilator requirements post-surgery.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Angiotensin converting enzyme (ACE) inhibitors are associated with adverse events during coronary artery bypass graft (CABG) surgery, including hypotension and increased vasoconstrictor needs.
- Preoperative omission of ACE inhibitors may enhance perioperative cardiovascular stability.
Purpose of the Study:
- To prospectively evaluate the impact of omitting regular ACE inhibitor medication before CABG surgery on hemodynamic variables and vasoactive drug usage.
Main Methods:
- A prospective study of 40 patients with good left ventricular function undergoing CABG surgery.
- Patients were randomly allocated to either omit or continue ACE inhibitor medication preoperatively.
- Hemodynamic variables (arterial pressure, cardiac output, systemic vascular resistance) and vasoactive drug use were monitored during anesthesia and the early postoperative period.
Main Results:
- Patients omitting ACE inhibitors demonstrated greater mean arterial pressure and required fewer vasopressors during cardiopulmonary bypass (CPB).
- However, the omission group necessitated more vasodilators to manage post-CPB and early postoperative hypertension.
- No significant differences were observed in hypotension during anesthesia induction or vasoconstrictor use after CPB.
Conclusions:
- Omitting ACE inhibitors before CABG surgery did not confer a significant perioperative advantage.
- The findings do not support the routine recommendation of discontinuing ACE inhibitors prior to CABG surgery.
Abstract:
Adverse events during coronary artery bypass graft (CABG) surgery have been described in patients receiving angiotensin converting enzyme (ACE) inhibitors, including hypotension on induction of anaesthesia and an increase in vasoconstrictor requirements after cardiopulmonary bypass (CPB). Omitting regular ACE inhibitor medication before surgery may improve cardiovascular stability during anaesthesia. We evaluated prospectively the effect of omitting regular ACE inhibitor medication before CABG surgery on haemodynamic variables and use of vasoactive drugs. We studied 40 patients with good left ventricular function, allocated randomly to omit or continue ACE inhibitor medication before surgery. Arterial pressure, cardiac output, systemic vascular resistance and use of vasoactive drugs were recorded during anaesthesia and in the early postoperative period. Patients who omitted their ACE inhibitors had greater mean arterial pressure during the study and required less vasopressors during CPB. However, these patients required more vasodilators to control hypertension after CPB and in the early postoperative period. There was no difference in hypotension on induction of anaesthesia or in the use of vasoconstrictors after CPB. We conclude that omitting ACE inhibitors before surgery did not have sufficient advantage to be recommended routinely.