Fang Zhe Amy, Palmer Jonathan, Geisler Kristie, Winterberg Abby V, Sinton Jamie
Department of Pediatric Anesthesiology and Pain Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Gordon College, Boston, Massachusetts, USA.
Paediatr Anaesth. 2025 Oct;35(10):848-855. doi: 10.1111/pan.70004. Epub 2025 Jun 27.
Perioperative management of angiotensin inhibitors is contentious in adults and understudied in children. Perioperative angiotensin inhibitor management in pediatrics cannot be extrapolated from adult literature because of dynamic neurohormonal pediatric physiology and uniquely pediatric indications for angiotensin inhibitor therapy. There is limited evidence for whether angiotensin inhibitors should be held in the perioperative setting in the pediatric population.
The aim of this study is to assess whether perioperative angiotensin inhibitor use is associated with intraoperative hypotension in the pediatric population.
This is a single center, retrospective cohort study. Data collection comprised demographics, angiotensin inhibitor dose timing and intraoperative blood pressure. Participants patients were divided into two groups based on recency of dose of angiotensin inhibitor, Recents had angiotensin inhibitor therapy within 2 days and Remotes had angiotensin inhibitor therapy between 2 and 30 days. Logistic regression with covariate adjustment and propensity score matching were performed to control confounding. Regression analysis and Chi-squared test were used to compare the incidence of hypotension between the two groups.
Four hundred ninety patients were included in the study prior to propensity score matching. We found the overall incidence of hypotension to be 29% (142/490). There was no difference in the incidence of hypotension by recency of angiotensin inhibitor dose between the two groups prior to matching, Recents 25.4% (59/232), Remotes 32% (83/258), p = 0.06. Adjusting for covariates, the odds ratio for hypotension is 0.73 (0.48-1.10, p = 0.129) for Recents compared to Remotes. After propensity score matching, there were 184 patients in each group. There remained no difference in the incidence of hypotension in the between the two groups, Recents 27% (50/184), Remotes 33% (61/184), p = 0.13.
We found no evidence to support the practice of abstaining from angiotensin inhibitor use in pediatric surgical patients for concern of intraoperative hypotension.
血管紧张素抑制剂的围手术期管理在成人中存在争议，而在儿童中研究较少。由于儿童动态的神经激素生理学以及血管紧张素抑制剂治疗独特的儿科适应症，儿科围手术期血管紧张素抑制剂的管理不能从成人文献中推断出来。关于在儿科人群围手术期是否应停用血管紧张素抑制剂，证据有限。
本研究的目的是评估儿科人群围手术期使用血管紧张素抑制剂是否与术中低血压有关。
这是一项单中心回顾性队列研究。数据收集包括人口统计学、血管紧张素抑制剂剂量时间和术中血压。参与者根据血管紧张素抑制剂剂量的近期情况分为两组，近期组在2天内接受血管紧张素抑制剂治疗，远期组在2至30天内接受血管紧张素抑制剂治疗。进行协变量调整的逻辑回归和倾向评分匹配以控制混杂因素。使用回归分析和卡方检验比较两组之间低血压的发生率。
在倾向评分匹配之前，490名患者被纳入研究。我们发现低血压的总体发生率为29%（142/490）。匹配前两组之间，根据血管紧张素抑制剂剂量的近期情况，低血压发生率没有差异，近期组为25.4%（59/232），远期组为32%（83/258），p = 0.06。调整协变量后，与远期组相比，近期组低血压的优势比为0.73（0.48 - 1.10，p = 0.129）。倾向评分匹配后，每组有184名患者。两组之间低血压发生率仍然没有差异，近期组为27%（50/184），远期组为33%（61/184），p = 0.13。
我们没有发现证据支持因担心术中低血压而在儿科手术患者中停用血管紧张素抑制剂的做法。
