长期接受血管紧张素II受体拮抗剂治疗的血管外科患者麻醉诱导的血流动力学效应。

The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists.

作者信息

Brabant S M, Bertrand M, Eyraud D, Darmon P L, Coriat P

机构信息

Department of Anesthesiology, University Hospital Pitié-Salpêtrière, Paris, France.

出版信息

Anesth Analg. 1999 Dec;89(6):1388-92. doi: 10.1097/00000539-199912000-00011.

DOI:10.1097/00000539-199912000-00011

PMID:10589613

Abstract

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.

摘要

未标记

血管紧张素II 1型受体拮抗剂（ARA）作为抗高血压药物最近开始使用，其应用正变得越来越普遍。我们研究了12例术前早晨一直使用ARA治疗的患者在全身麻醉诱导后低血压的发生率和严重程度。将诱导时的血流动力学反应与使用β-肾上腺素能阻滞剂（BB）和/或钙通道阻滞剂（CB）治疗的患者（BB/CB组，n = 45）以及使用血管紧张素转换酶抑制剂（ACEI）治疗的患者（ACEI组，n = 27）进行比较。所有患者均遵循标准化的麻醉诱导方案。与BB/CB治疗的患者（45例中的27例）或ACEI治疗的患者（27例中的18例）相比，ARA治疗的患者（12例中的12例）低血压发生明显更频繁（p≤0.05）。与BB/CB组（10±6mg）或ACEI组（7±4mg）相比，ARA组（21±3mg）麻黄碱需求量明显增加（P≤0.001）。与BB/CB组（45例中的0例）或ACEI组（27例中的1例）相比，ARA组（12例中的4例）对重复给予麻黄碱或去氧肾上腺素治疗无效的低血压发生明显更多（P≤0.05），但通过使用血管加压素系统激动剂成功治疗。手术当天之前使用血管紧张素II拮抗剂治疗与麻醉诱导后严重低血压相关，在某些情况下，只能用血管加压素系统激动剂治疗。