Hojo Takayuki, Shibuya Makiko, Kimura Yukifumi, Otsuka Yuki, Fujisawa Toshiaki
Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan.
Anesth Prog. 2020 Jun 1;67(2):86-89. doi: 10.2344/anpr-67-02-02.
Angiotensin receptor blockers (ARBs) are commonly used to treat hypertension. However, similar to angiotensin-converting enzyme inhibitors, ARBs can also cause refractory hypotension during general anesthesia. Therefore, it has been recommended that ARBs be withheld for 24 hours prior to the induction of anesthesia. This is a case report of refractory hypotension requiring the administration of potent vasopressors after the induction of general anesthesia despite withholding telmisartan for 24 hours. In the same patient undergoing a subsequent general anesthetic, telmisartan was withheld for 5 days before induction, leading to mild intraoperative hypotension that responded adequately to phenylephrine. The primary cause of refractory hypotension during the first general anesthetic was suspected to be an insufficient telmisartan washout period. Telmisartan's half-life of 24 hours is notably the longest of all ARBs in current use. This case report demonstrates that refractory hypotension during general anesthesia cannot always be avoided by withholding telmisartan for 24 hours before the induction of anesthesia. Therefore, a washout period greater than 24 hours is preferable for patients taking telmisartan.
血管紧张素受体阻滞剂（ARBs）常用于治疗高血压。然而，与血管紧张素转换酶抑制剂类似，ARBs在全身麻醉期间也可导致难治性低血压。因此，建议在麻醉诱导前24小时停用ARBs。本文报告一例尽管在麻醉诱导前24小时停用替米沙坦，但全身麻醉诱导后仍需使用强效血管升压药治疗的难治性低血压病例。在同一患者随后进行的全身麻醉中，诱导前停用替米沙坦5天，导致术中出现轻度低血压，对去氧肾上腺素反应良好。首次全身麻醉期间难治性低血压的主要原因被怀疑是替米沙坦清除期不足。替米沙坦24小时的半衰期在目前使用的所有ARBs中明显是最长的。本病例报告表明，在麻醉诱导前24小时停用替米沙坦并不能总是避免全身麻醉期间的难治性低血压。因此，对于服用替米沙坦的患者，清除期大于24小时更为可取。
