Key result
Withholding telmisartan for 24 hours prior to general anesthesia was insufficient to prevent refractory hypotension, whereas a 5-day washout period successfully prevented it in the same patient.
Why the study?
ARBs can cause refractory hypotension during general anesthesia despite recommendations to withhold them for 24 hours prior to induction.
Does withholding telmisartan for more than 24 hours prevent refractory hypotension during general anesthesia in patients taking telmisartan?
Case Report (n=1)
No
Does withholding telmisartan for more than 24 hours prevent refractory hypotension during general anesthesia in patients taking telmisartan?
Withholding telmisartan for the standard 24 hours prior to general anesthesia may be insufficient to prevent refractory hypotension due to its long half-life, suggesting a longer washout period is needed.
Warrants vasopressor preparedness in ARB patients despite 24h withholding; leaves open optimal preoperative discontinuation timing.
Angiotensin receptor blockers (ARBs) are commonly used to treat hypertension. However, similar to angiotensin-converting enzyme inhibitors, ARBs can also cause refractory hypotension during general anesthesia. Therefore, it has been recommended that ARBs be withheld for 24 hours prior to the induction of anesthesia. This is a case report of refractory hypotension requiring the administration of potent vasopressors after the induction of general anesthesia despite withholding telmisartan for 24 hours. In the same patient undergoing a subsequent general anesthetic, telmisartan was withheld for 5 days before induction, leading to mild intraoperative hypotension that responded adequately to phenylephrine. The primary cause of refractory hypotension during the first general anesthetic was suspected to be an insufficient telmisartan washout period. Telmisartan's half-life of 24 hours is notably the longest of all ARBs in current use. This case report demonstrates that refractory hypotension during general anesthesia cannot always be avoided by withholding telmisartan for 24 hours before the induction of anesthesia. Therefore, a washout period greater than 24 hours is preferable for patients taking telmisartan.
No takes yet. Share an insight, caveat, or question.
Hojo et al. (2020) conducted a case report in Refractory hypotension during general anesthesia (n=1). Withholding telmisartan for 24 hours vs. Withholding telmisartan for 5 days was evaluated on Refractory hypotension. Withholding telmisartan for 24 hours prior to general anesthesia was insufficient to prevent refractory hypotension, whereas a 5-day washout period successfully prevented it in the same patient.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: