Comfere Thomas, Sprung Juraj, Kumar Matthew M, Draper Myongsu, Wilson Diana P, Williams Brent A, Danielson David R, Liedl Lavonne, Warner David O
*Department of Anesthesiology and †Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota.
Anesth Analg. 2005 Mar;100(3):636-644. doi: 10.1213/01.ANE.0000146521.68059.A1.
We studied the relationship between the timing of discontinuing chronic angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor subtype 1 antagonists (ARA) and hypotension after the induction of general anesthesia in a general surgical population. We retrospectively studied 267 hypertensive patients receiving chronic ACEI/ARA therapy undergoing elective noncardiac surgery under general anesthesia. During preoperative visits, patients were asked to either take their last ACEI/ARA therapy on the morning of surgery or withhold it up to 24 h before surgery. The number of hours from the last ACEI/ARA dose to surgery was recorded during the preoperative interview. Electronic medical and anesthesia records were reviewed for comorbidities, type and dose of anesthetics used, intraoperative hemodynamics, IV fluids, perioperative vasopressor administration, and rate of severe postoperative complications. Arterial blood pressure (BP) and heart rate were recorded during the 60-min postinduction period, and hypotension was classified as moderate (systolic BP <or=85 mm Hg) and severe (systolic BP <or=65 mm Hg). We analyzed all variables separately for patients who took their last ACEI/ARA therapy <10 h and >or=10 h before surgery. During the first 30 min after anesthetic induction, moderate hypotension was more frequent in patients whose most recent ACEI/ARA therapy was taken <10 h (60%) compared with those who stopped it >or=10 h (46%) before induction (P = 0.02). The adjusted odds ratio for moderate hypotension was 1.74 (95% confidence interval, 1.03-2.93) for those who took their ACEI/ARA therapy <10 h before surgery (P = 0.04). There were no differences between groups in the incidence of severe hypotension, nor was there a difference in the use of vasopressors. During the 31-60 min after induction, the incidence of either moderate (P = 0.43) or severe (P = 0.97) hypotension was similar in the two groups. No differences in postoperative complications were found between groups. In conclusion, discontinuation of ACEI/ARA therapy at least 10 h before anesthesia was associated with a reduced risk of immediate postinduction hypotension.
我们研究了普通外科患者中停用慢性血管紧张素转换酶抑制剂（ACEI）和血管紧张素II 1型受体拮抗剂（ARA）的时间与全身麻醉诱导后低血压之间的关系。我们回顾性研究了267例接受慢性ACEI/ARA治疗并在全身麻醉下接受择期非心脏手术的高血压患者。在术前访视期间，要求患者要么在手术当天早上服用最后一剂ACEI/ARA，要么在手术前24小时停用。在术前访谈中记录从最后一剂ACEI/ARA到手术的小时数。查阅电子病历和麻醉记录，了解合并症、所用麻醉剂的类型和剂量、术中血流动力学、静脉输液、围手术期血管升压药的使用以及严重术后并发症的发生率。在诱导后60分钟内记录动脉血压（BP）和心率，低血压分为中度（收缩压≤85 mmHg）和重度（收缩压≤65 mmHg）。我们分别分析了手术前<10小时和≥10小时服用最后一剂ACEI/ARA的患者的所有变量。在麻醉诱导后的前30分钟内，最近一次服用ACEI/ARA在<10小时的患者中中度低血压更为常见（60%），而在诱导前≥10小时停药的患者中为46%（P = 0.02）。手术前<10小时服用ACEI/ARA的患者发生中度低血压的校正比值比为1.74（95%置信区间，1.03 - 2.93）（P = 0.04）。两组之间重度低血压的发生率没有差异，血管升压药的使用也没有差异。在诱导后31 - 60分钟内，两组中度（P = 0.43）或重度（P = 0.97）低血压的发生率相似。两组之间术后并发症没有差异。总之，在麻醉前至少10小时停用ACEI/ARA治疗与诱导后立即发生低血压的风险降低有关。
