Key result
Long-term ACE inhibitor treatment did not aggravate blood pressure decrease during TIVA for minor surgery, although angiotensin II increased only in controls (6.2 vs 9.6 pg/ml; P<0.05).
Why the study?
Does long-term ACEI treatment impair haemodynamic regulation during total intravenous anaesthesia for minor surgery?
Observational (n=36)
Does long-term ACEI treatment impair haemodynamic regulation during total intravenous anaesthesia for minor surgery?
Long-term ACEI treatment does not aggravate blood pressure decrease during TIVA for minor surgery, suggesting it is safe to continue ACEIs prior to such procedures if managed appropriately.
ACEI continuation may not worsen BP drops in minor surgery TIVA; leaves open effects in major cases or other anaesthetics.
BACKGROUND: This study investigates whether long-term treatment with an angiotensin-converting enzyme inhibitor (ACEI) impairs the haemodynamic regulation during total intravenous anaesthesia (TIVA) for minor surgery. METHODS: In a prospective, two-armed observational study, 36 patients undergoing TIVA for minor surgery were studied. Seventeen were taking ACEIs regularly but no other antihypertensive medication (ACEI group); 19 patients without any cardiovascular medication served as controls (non-ACEI group). Haemodynamic variables were measured every minute during induction and every 5 min during surgery. The plasma levels of renin, angiotensin II, vasopressin and catecholamines were measured before and 18 min after the induction of anaesthesia. RESULTS: The mean arterial pressure decreased to the same extent in both the groups during the induction of TIVA. There were also no differences between the groups regarding the heart rate, systolic and diastolic arterial pressure, as well as the use of vasoconstrictors, and fluids during induction and throughout surgery. In the ACEI group, the plasma renin concentration was higher at baseline and after the induction of anaesthesia presumably due to the interruption of the negative renin-angiotensin feedback loop (P<0.05). Angiotensin II increased only in the non-ACEI group (6.2 ± 2.2 before vs. 9.6 ± 3.5 pg/ml after induction; P<0.05). In both groups, the plasma norepinephrine concentration decreased after the induction of TIVA (P<0.05). Plasma vasopressin and plasma epinephrine concentrations did not change in either group. CONCLUSION: Long-term ACEI treatment does not further aggravate the blood pressure decrease under TIVA during minor surgery, provided the induction procedure is slow, the patient is kept well hydrated and vasoconstrictors are promptly applied.
No takes yet. Share an insight, caveat, or question.
Schulte et al. (2011) conducted an observational in Minor surgery under total intravenous anaesthesia (n=36). Long-term angiotensin-converting enzyme inhibitor (ACEI) therapy vs. No cardiovascular medication was evaluated on Mean arterial pressure decrease during induction of TIVA. Long-term ACE inhibitor treatment did not aggravate blood pressure decrease during TIVA for minor surgery, although angiotensin II increased only in controls (6.2 vs 9.6 pg/ml; P<0.05).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: