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Hemodynamic effects of anesthesia in patients chronically treated with angiotensin-converting enzyme inhibitors
P Colson1, M Saussine, J R Séguin
1Department of Anesthesiology, Centre Hospitalo-Universitaire, Montpellier, France.
Insights
Patients on angiotensin-converting enzyme inhibitors (ACEIs) experience greater blood pressure drops during anesthesia induction. Prompt fluid resuscitation and vasopressors effectively managed these hemodynamic changes in ACEI-treated patients.
Area of Science:
- Anesthesiology
- Cardiovascular Pharmacology
- Critical Care Medicine
Background:
- Angiotensin-converting enzyme inhibitors (ACEIs) are widely used for cardiovascular disease.
- Emerging reports suggest potential hemodynamic risks, including hypotension and bradycardia, when ACEIs are combined with anesthesia.
- This necessitates a closer examination of anesthetic effects in patients on chronic ACEI therapy.
Purpose of the Study:
- To evaluate the hemodynamic impact of anesthesia induction in hypertensive patients on chronic ACEI treatment.
- To compare these effects against a control group receiving other antihypertensive medications.
Main Methods:
- A comparative study involving 16 hypertensive patients undergoing major surgery.
- Eight patients were on chronic ACEI therapy (ACEI group); eight received other antihypertensives (control group).
- Anesthesia induction involved flunitrazepam, fentanyl, and pancuronium, with hemodynamic parameters monitored.
Main Results:
- Anesthesia induction caused significant mean arterial blood pressure decrease in both groups, more pronounced in the ACEI group (33.5% vs. 16.8%).
- ACEI patients showed significant reductions in pulmonary capillary wedge pressure and cardiac index.
- Hemodynamic stability was rapidly restored in ACEI patients with fluid administration and, in some cases, phenylephrine.
Conclusions:
- Anesthesia induction leads to more significant hypotension in patients chronically treated with ACEIs.
- Pulmonary capillary wedge pressure and cardiac index reductions are key hemodynamic changes in ACEI-treated patients during induction.
- Careful hemodynamic monitoring and prompt management strategies are crucial for patients on ACEIs undergoing anesthesia.
Abstract:
Angiotensin-converting enzyme inhibitors (ACEIs) are increasingly used in the treatment of cardiovascular disease, but recent reports have warned of some hemodynamic risk (hypotension and bradycardia) when associated with anesthesia. To assess the hemodynamic effects of induction of anesthesia in patients chronically treated with ACEIs, 16 hypertensive patients scheduled for coronary artery bypass graft surgery (n = 12) or vascular surgery (n = 4) were studied. Eight of them were chronically treated (for at least 1 mo) with ACEIs (ACEI group), and the remaining eight (control group) were treated with other classes of antihypertensive drugs. Induction of anesthesia, which consisted of flunitrazepam (0.03 mg/kg), fentanyl (0.006 mg/kg), and pancuronium (0.1 mg/kg) IV, was followed by a significant decrease in mean arterial blood pressure from baseline in both groups (by 16.8% in controls [P = 0.001] and 33.5% in ACEI-treated patients [P = 0.001] [P = 0.041 between groups]). In control patients, mean arterial blood pressure decrease was only associated with a significant decrease in cardiac index (-18%, P = 0.014). In ACEI-treated patients, the arterial blood pressure decreases were associated with consistent reductions in pulmonary capillary wedge pressure (-26.4%; P = 0.035) and cardiac index (-23.9%; P = 0.001). Systemic vascular resistance index and heart rate were moderately changed (-14.2% and -4.5%, respectively). Rapid restoration of arterial blood pressure was obtained in all ACEI-treated patients, mainly with the intravenous administration of 0.4 to 0.7 L of lactated Ringer's solution. Phenylephrine (0.38 +/- 0.9 mg) was, however, required in four patients when mean arterial blood pressure was less than 60 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)