A national survey of 105 UK cardiac surgeons revealed divided opinions on stopping preoperative ACE inhibitors, with 39% believing it beneficial, 38% harmful, and 20% feeling it made no difference.
Cross-Sectional (n=105)
What are the opinions and practices of UK cardiac surgeons regarding stopping preoperative angiotensin-converting enzyme inhibitors?
There is significant variation in opinion and practice among UK cardiac surgeons regarding the preoperative cessation of ACE inhibitors, highlighting the need for randomized trials.
Preoperative use of angiotensin-converting enzyme inhibitors in cardiac surgery patients is thought to cause extreme vasodilatation in post cardiopulmonary bypass period. Opinions are divided as to whether it is beneficial or not to stop it prior to operation. A national survey in the UK was carried out on this issue. Questionnaires were sent to 167 currently practicing UK cardiac surgeons, out of which 105 (62%) replied back. Their responses were analyzed. Among the surgeons who replied to the questionnaires, the majority (63%) were of the opinion that the use of angiotensin-converting enzyme inhibitors leads to vasodilatation resulting in increased usage of fluids, inotropes and vasoconstrictors. However, there was no agreement on the issue of stopping it prior to surgery. Forty one (39%) felt it was beneficial to stop the angiotensin-converting enzyme inhibitors prior to surgery whereas 40 (38%) of them thought it was harmful to stop it. Twenty one (20%) were of the opinion that it made no difference. 39% of respondents practiced stopping the drug prior to planned operation. This national survey revealed differences in management of patients on angiotensin-converting enzyme inhibitors undergoing cardiac surgery. Recommendations from available literature are equally varied, highlighting the need for multicenter randomized trials to address this clinical problem.
Devbhandari et al. (2004) conducted a cross-sectional in Cardiac surgery patients on ACE inhibitors (n=105). Preoperative angiotensin-converting enzyme inhibition was evaluated on Surgeon opinions on stopping ACE inhibitors prior to surgery. A national survey of 105 UK cardiac surgeons revealed divided opinions on stopping preoperative ACE inhibitors, with 39% believing it beneficial, 38% harmful, and 20% feeling it made no difference.