Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea.
Medicine (Baltimore). 2023 Nov 24;102(47):e36126. doi: 10.1097/MD.0000000000036126.
Angiotensin II receptor blockers (ARBs) are currently considered first-line antihypertensive drugs, effectively inhibiting the renin-angiotensin-aldosterone system. However, ARBs have been associated with intraoperative hypotension during general anesthesia. Although it is recommended to discontinue ARBs for 24 hours before surgery, the optimal duration of discontinuation remains unclear. We present a severe refractory hypotension encountered during general anesthesia despite discontinuing ARBs for 48 hours before anesthesia.
A severe refractory hypotension occurred during the induction of general anesthesia for cranioplasty in a 66-year-old male patient (170 cm/75 kg). The patient was taking azilsartan, angiotensin receptor blocker, for hypertension, which was discontinued 48 hours before anesthesia induction. Despite repeated administration of ephedrine and continuous infusion of norepinephrine, hemodynamic instability did not improve. Therefore, the surgery was postponed.
The patient was diagnosed with angiotensin receptor blocker-induced refractory hypotension.
Before the second surgery, the angiotensin receptor blocker was discontinued 96 hours prior to the surgery. Invasive blood pressure monitoring was performed before anesthesia induction, and vasopressin was prepared. General anesthesia was induced using remimazolam and maintained with desflurane.
The surgery was completed successfully without occurrence of refractory hypotension.
Refractory hypotension induced by Angiotensin receptor blockers can still occur even after discontinuing the medication for 48 hours before induction of general anesthesia. Despite withholding the medication, caution should be practiced regarding hypotension during general anesthesia in patient taking ARBs.
血管紧张素 II 受体阻滞剂（ARBs）目前被认为是一线降压药物，能有效抑制肾素-血管紧张素-醛固酮系统。然而，ARBs 与全身麻醉期间的术中低血压有关。尽管建议在手术前停止使用 ARBs24 小时，但最佳停药时间仍不清楚。我们报告了一例在全身麻醉诱导期间发生的严重难治性低血压，尽管在麻醉前已经停止使用 ARBs48 小时。
一名 66 岁男性患者（170cm/75kg）因颅骨成形术行全身麻醉诱导时发生严重难治性低血压。患者因高血压服用阿齐沙坦（ARB），在麻醉诱导前 48 小时停药。尽管反复给予麻黄碱和持续输注去甲肾上腺素，血流动力学仍不稳定，因此手术被推迟。
患者被诊断为 ARB 引起的难治性低血压。
在第二次手术前，ARB 在手术前 96 小时停止使用。在麻醉诱导前进行有创血压监测，并准备好血管加压素。使用瑞马唑仑诱导全身麻醉，并用地氟醚维持。
手术成功完成，无难治性低血压发生。
即使在全身麻醉诱导前停止使用 ARBs48 小时后，仍可能发生由 ARBs 引起的难治性低血压。尽管停药，但对于正在服用 ARBs 的患者，在全身麻醉期间仍应注意低血压。
