Possible interaction between SPPS and enalapril

A patient undergoing groin lymph node dissection with spinal and general anaesthesia was receiving enalapril to control hypertension. Infusion of stable plasma protein solution (Commonwealth Serum Laboratories, Australia) was associated with significant hypotension and flushing. A brief review of stable plasma protein solution and angiotensin converting enzyme inhibitor pharmacology is presented to provide a possible mechanism for these events. This mechanism implies that angiotensin converting enzyme inhibitor therapy is a relative contraindication to rapid SPPS infusion.