Salvetti Guido, Di Salvo Claudio, Ceccarini Giovanni, Abramo Antonio, Fierabracci Paola, Magno Silvia, Piaggi Paolo, Vitti Paolo, Santini Ferruccio
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Unit of Anaesthesia and Reanimation in Obesity Surgery and Diseases of Upper Gut, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Obes Surg. 2016 Jun;26(6):1303-7. doi: 10.1007/s11695-015-1862-9.
The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes.
血管紧张素转换酶抑制剂（ACE-I）和血管紧张素II受体阻滞剂（ARB）用于治疗高血压肥胖患者的情况正在稳步增加。一些研究报告称，在全身麻醉期间使用这些药物与低血压发作风险增加有关。全球范围内减肥手术的数量也在增加，但缺乏关于肾素-血管紧张素系统（RAS）阻滞剂在肥胖症手术全身麻醉期间对严重肥胖患者降压作用的研究。这项初步研究的目的是评估与未接受抗高血压治疗的对照组相比，长期接受ACE-I或ARB治疗的肥胖患者在全身麻醉下引起的血流动力学变化。14名接受ACE-I或ARB治疗的肥胖受试者（平均体重指数（BMI）为47.5kg/m²）和12名未接受抗高血压治疗的肥胖对照组（平均BMI为45.7kg/m²）接受全身麻醉以进行腹腔镜减肥手术。连续监测收缩压、舒张压和心率，并在不同时间点记录：诱导前的T0，然后在诱导后2、5、7、10、15、20、30、60、90、120和150分钟，以及麻醉恢复后的最后一个时间点。观察到收缩压和舒张压值均逐渐降低，两组之间无显著差异。观察到心率值有类似趋势。总之，我们的初步研究表明，接受减肥手术的患者在围手术期可以继续使用RAS阻滞剂，而不会增加低血压发作的风险。
