Chronic ACEI treatment in patients with ischemic left ventricle dysfunction did not increase the incidence of severe hypotension after anesthesia induction (22.2% vs 22.2%).
Observational (n=18)
Does chronic ACEI treatment alter hemodynamics or increase the incidence of severe hypotension after induction of anesthesia in patients with ischemic left ventricle dysfunction?
Chronic ACEI treatment in patients with ischemic LV dysfunction decreases cardiac index but does not increase the incidence of severe hypotension during anesthesia induction for CABG.
Absolute Event Rate: 22.2% vs 22.2%
Anesthesia may induce hemodynamic instability in patients treated with angiotensin-converting enzyme inhibitors (ACEIs). To assess the hemodynamic effects of anesthesia in patients treated (n = 9) or not treated (n = 9) with ACEIs for ischemic left ventricle dysfunction after myocardial infarction, we studied 18 patients scheduled for elective coronary artery bypass graft surgery. Induction of anesthesia with fentanyl (5 micrograms/kg), flunitrazepam (30 micrograms/kg), and pancuronium (100 micrograms/kg) was followed by a significant decrease in mean arterial blood pressure in both groups (-18.6% +/- 8.1% in controls and -25.7% +/- 7.8% in ACEI-treated patients, P = 0.01). In controls, cardiac index and systemic vascular resistance were not significantly altered (-11.2% +/- 9.4% and -16.2% +/- 4.6%, respectively, not significant NS). In ACEI-treated patients, cardiac index decreased significantly (-27.3% +/- 11.6%, P = 0.01 from baseline and P = 0.03 when compared with controls), and systemic vascular resistance was unchanged (1.0% +/- 18.7%, NS from baseline and P = 0.04 when compared with controls). Two patients from each group experienced a transient severe hypotensive episode. ACEI treatment in patients with infarction-induced myocardial dysfunction does not increase the incidence of severe hypotension after induction of anesthesia.
Ryckwaert et al. (1997) conducted an observational in Ischemic left ventricle dysfunction after myocardial infarction (n=18). Angiotensin-converting enzyme inhibitors (ACEIs) vs. No ACEI treatment was evaluated on Transient severe hypotensive episode. Chronic ACEI treatment in patients with ischemic left ventricle dysfunction did not increase the incidence of severe hypotension after anesthesia induction (22.2% vs 22.2%).