Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA.
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA.
J Cardiothorac Vasc Anesth. 2021 Feb;35(2):508-513. doi: 10.1053/j.jvca.2020.01.005. Epub 2020 Jan 11.
The aim of this study was to find out whether the preoperative continuation of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) treatment is associated with intraoperative hypotension immediately after induction of general anesthesia in elective noncardiac surgeries.
Retrospective cohort study.
Single institutional university hospital.
Four hundred patients who underwent elective noncardiac surgery under general anesthesia, with ACE-I or ARB on their list of preoperative home medications, were included.
Preoperative ACE-I and ARB use was evaluated, and patients were divided into an ACE-I/ARB group versus non-ACE-I/ARB group.
The primary outcome measure was intraoperative hypotension after induction of general anesthesia. The secondary outcome measure was preoperative medication use, medications taken the morning of surgery, induction medication and dosage, and vasopressor medication use during induction.
Three hundred forty-nine patients were included for final analysis. The mean admission American Society of Anesthesiologists status was 2.7 ± 0.5, age 65 ± 11 years, and body mass index 31 ± 6.9 kg/m. There were no statistically significant changes between the no ACE-I/ARB group and the ACE-I/ARB group in systolic blood pressure (p = 0.853), diastolic blood pressure (p = 0.357), and heart rate (p = 0.220) change over the 15 minutes. There was no statistical difference in induction medication dose (propofol, fentanyl, and rocuronium) and pressor use (p = 0.137) for hypotension between the 2 groups. Statistically significant hypotension (p < 0.001) occurred in both groups equally over 15 minutes.
Continuation of ACE-I/ARB on the day of surgery was not associated with increased risk of intraoperative hypotension upon induction and within 15 minutes of general anesthesia in elective noncardiac surgeries.
本研究旨在探讨在择期非心脏手术中，全麻诱导后即刻发生术中低血压时，术前继续使用血管紧张素转换酶抑制剂（ACE-I）或血管紧张素 II 受体阻滞剂（ARB）是否相关。
回顾性队列研究。
单机构大学医院。
共纳入 400 例接受全麻择期非心脏手术、术前家中服用 ACE-I 或 ARB 的患者。
评估术前 ACE-I 和 ARB 使用情况，并将患者分为 ACE-I/ARB 组和非 ACE-I/ARB 组。
主要结局指标为全麻诱导后发生的术中低血压。次要结局指标为术前用药、手术当天早上用药、诱导用药和剂量、诱导期间使用血管加压药。
最终纳入 349 例患者进行分析。平均入院美国麻醉医师协会（ASA）分级为 2.7 ± 0.5，年龄 65 ± 11 岁，体重指数 31 ± 6.9 kg/m²。在收缩压（p = 0.853）、舒张压（p = 0.357）和心率（p = 0.220）在 15 分钟内的变化方面，无 ACE-I/ARB 组和 ACE-I/ARB 组之间无统计学差异。两组之间诱导药物剂量（丙泊酚、芬太尼和罗库溴铵）和低血压时使用升压药（p = 0.137）无统计学差异。两组在 15 分钟内均出现明显的低血压（p < 0.001）。
在择期非心脏手术中，手术当天继续使用 ACE-I/ARB 并不会增加全麻诱导后和 15 分钟内发生术中低血压的风险。
