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Published on: May 26, 2022
Retrospective Review of Intraoperative Hypotension and Perioperative Angiotensin Inhibitor Use in Pediatrics
Zhe Amy Fang1, Jonathan Palmer2, Kristie Geisler3
1Department of Pediatric Anesthesiology and Pain Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Insights
This study found no increased risk of intraoperative hypotension in pediatric patients who continued angiotensin inhibitors before surgery. These findings suggest that withholding these vital medications is unnecessary for children undergoing procedures.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Pharmacology
Background:
- Perioperative management of angiotensin inhibitors is controversial in pediatric patients.
- Pediatric physiology differs from adults, necessitating specific evidence for children.
- Limited data exists on the safety of continuing angiotensin inhibitors during pediatric surgery.
Purpose of the Study:
- To determine if perioperative angiotensin inhibitor use is associated with intraoperative hypotension in children.
- To provide evidence-based guidance for managing angiotensin inhibitors in pediatric surgical patients.
Main Methods:
- Retrospective cohort study at a single center.
- Compared hypotension incidence in pediatric patients receiving angiotensin inhibitors within 2 days (Recents) versus 2-30 days (Remotes) preoperatively.
- Utilized logistic regression with covariate adjustment and propensity score matching.
Main Results:
- No significant difference in intraoperative hypotension incidence between Recents and Remotes groups, both before and after propensity score matching.
- Overall hypotension incidence was 29%.
- Adjusted odds ratio for hypotension in Recents vs. Remotes was 0.73 (p=0.129).
Conclusions:
- No evidence supports withholding angiotensin inhibitors in pediatric surgical patients due to concerns about intraoperative hypotension.
- Current practice of abstaining from these medications may not be necessary.
- Further research could explore specific pediatric populations or drug classes.
Background:
Perioperative management of angiotensin inhibitors is contentious in adults and understudied in children. Perioperative angiotensin inhibitor management in pediatrics cannot be extrapolated from adult literature because of dynamic neurohormonal pediatric physiology and uniquely pediatric indications for angiotensin inhibitor therapy. There is limited evidence for whether angiotensin inhibitors should be held in the perioperative setting in the pediatric population.
Aims:
The aim of this study is to assess whether perioperative angiotensin inhibitor use is associated with intraoperative hypotension in the pediatric population.
Methods:
This is a single center, retrospective cohort study. Data collection comprised demographics, angiotensin inhibitor dose timing and intraoperative blood pressure. Participants patients were divided into two groups based on recency of dose of angiotensin inhibitor, Recents had angiotensin inhibitor therapy within 2 days and Remotes had angiotensin inhibitor therapy between 2 and 30 days. Logistic regression with covariate adjustment and propensity score matching were performed to control confounding. Regression analysis and Chi-squared test were used to compare the incidence of hypotension between the two groups.
Results:
Four hundred ninety patients were included in the study prior to propensity score matching. We found the overall incidence of hypotension to be 29% (142/490). There was no difference in the incidence of hypotension by recency of angiotensin inhibitor dose between the two groups prior to matching, Recents 25.4% (59/232), Remotes 32% (83/258), p = 0.06. Adjusting for covariates, the odds ratio for hypotension is 0.73 (0.48-1.10, p = 0.129) for Recents compared to Remotes. After propensity score matching, there were 184 patients in each group. There remained no difference in the incidence of hypotension in the between the two groups, Recents 27% (50/184), Remotes 33% (61/184), p = 0.13.
Conclusion:
We found no evidence to support the practice of abstaining from angiotensin inhibitor use in pediatric surgical patients for concern of intraoperative hypotension.
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