Angiotensin II receptor antagonists continued until surgery caused hypotension after anesthetic induction in 100% of patients, compared to 60% with BB/CB and 67% with ACEI (P<=0.05).
Observational (n=84)
Does continuation of angiotensin II receptor antagonists until the morning of surgery increase the risk of severe hypotension after anesthetic induction in vascular surgical patients compared to other antihypertensives?
Continuing angiotensin II receptor antagonists until the morning of vascular surgery significantly increases the risk of severe, refractory hypotension during anesthetic induction compared to other antihypertensive classes.
Absolute Event Rate: 100% vs 60%
p-value: p=<=0.05
UNLABELLED: The use of angiotensin II receptor subtype-1 antagonists (ARA), recently introduced as antihypertensive drugs, is becoming more prevalent. We studied the prevalence and severity of hypotension after the induction of general anesthesia in 12 patients treated with ARA until the morning of surgery. The hemodynamic response to induction was compared with that of patients treated with beta-adrenergic blockers (BB) and/or calcium channel blockers (CB) (BB/CB group, n = 45) and angiotensin-converting enzyme inhibitors (ACEI) (ACEI group, n = 27). A standardized anesthesia induction protocol was followed for all patients. Hypotension occurred significantly (p < or = 0.05) more often in ARA-treated patients (12 of 12) compared with BB/CB-treated patients (27 of 45) or with ACEI-treated patients (18 of 27). There was a significantly (P < or = 0.001) increased ephedrine requirement in the ARA group (21+/-3 mg) compared with the BB/CB group (10+/-6 mg) or the ACEI group (7+/-4 mg). Hypotension refractory to repeated ephedrine or phenylephrine administration occurred significantly (P < or = 0.05) more in the ARA group (4 of 12) compared with the BB/CB group (0 of 45) or the ACEI group (1 of 27), but it was treated successfully by using a vasopressin system agonist. Treatment with angiotensin II antagonism until the day of surgery is associated with severe hypotension after the induction of anesthesia, which, in some cases, can only be treated with an agonist of the vasopressin system. IMPLICATIONS: Hypotensive episodes occur more frequently after anesthetic induction in patients receiving Angiotensin II receptor subtype-1 antagonists under anesthesia than with other hypotensive drugs. They are less responsive to the vasopressors ephedrine and phenylephrine. The use of a vasopressin system agonist was effective in restoring blood pressure when hypotension was refractory to conventional therapy.
Brabant et al. (Wed,) conducted a observational in Vascular surgical patients (n=84). Angiotensin II receptor subtype-1 antagonists (ARA) vs. Beta-adrenergic blockers and/or calcium channel blockers (BB/CB), and ACE inhibitors (ACEI) was evaluated on Hypotension after the induction of general anesthesia (p=<=0.05). Angiotensin II receptor antagonists continued until surgery caused hypotension after anesthetic induction in 100% of patients, compared to 60% with BB/CB and 67% with ACEI (P<=0.05).