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Risk of intraoperative hypotension with loop diuretics: a randomized controlled trial.

Nadia A Khan¹, Norman R Campbell, Shaun D Frost

¹Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. nakhan@shaw.ca

The American Journal of Medicine

|November 2, 2010

Summary

This summary is machine-generated.

Continuing furosemide (a loop diuretic) on the day of noncardiac surgery did not increase the risk of intraoperative hypotension in chronic users. This study found similar hypotension rates between furosemide and placebo groups.

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Area of Science:

Anesthesiology
Cardiology
Pharmacology

Background:

Concerns exist regarding perioperative blood pressure medication safety.
The effect of loop diuretics like furosemide on intraoperative hypotension is unclear.
Chronic furosemide users undergoing surgery require clarity on perioperative management.

Purpose of the Study:

To compare the effects of continuing versus withholding furosemide on the day of noncardiac elective surgery.
To assess the risk of intraoperative hypotension in chronic furosemide users.
To evaluate secondary outcomes including cardiovascular events and renal function.

Main Methods:

A double-blind, randomized, placebo-controlled trial involving 212 patients.
Participants received either furosemide or placebo on the day of surgery.
Primary outcome: risk of intraoperative hypotension; secondary outcomes: heart failure, cardiovascular events, renal function, electrolytes.

Main Results:

No significant difference in intraoperative hypotension between furosemide (49%) and placebo (51.9%) groups (RR, 0.95; P = .78).
Similar rates of vasopressor and fluid administration between groups.
No significant difference in postoperative cardiovascular events (furosemide 4.8% vs. placebo 2.8%) or renal function/electrolytes.

Conclusions:

Continuing furosemide on the day of elective noncardiac surgery does not significantly increase the risk of intraoperative hypotension.
Perioperative management of furosemide in chronic users can be considered safe regarding hypotension.
The study provides evidence for current clinical practice regarding furosemide use in surgical patients.