Angiotensin system inhibitors in a general surgical population

Thomas Comfere, Juraj Sprung, Matthew M. Kumar, Myongsu Draper, Diana P. Wilson, Brent A. Williams, David R. Danielson, Lavonne Liedl, David Oman Warner

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

We studied the relationship between the timing of discontinuing chronic angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor subtype 1 antagonists (ARA) and hypotension after the induction of general anesthesia in a general surgical population. We retrospectively studied 267 hypertensive patients receiving chronic ACEI/ARA therapy undergoing elective noncardiac surgery under general anesthesia. During preoperative visits, patients were asked to either take their last ACEI/ARA therapy on the morning of surgery or withhold it up to 24 h before surgery. The number of hours from the last ACEI/ARA dose to surgery was recorded during the preoperative interview. Electronic medical and anesthesia records were reviewed for comorbidities, type and dose of anesthetics used, intraoperative hemodynamics, IV fluids, perioperative vasopressor administration, and rate of severe postoperative complications. Arterial blood pressure (BP) and heart rate were recorded during the 60-min postinduction period, and hypotension was classified as moderate (systolic BP ≤85 mm Hg) and severe (systolic BP ≤65 mm Hg). We analyzed all variables separately for patients who took their last ACEI/ARA therapy <10 h and ≥10 h before surgery. During the first 30 min after anesthetic induction, moderate hypotension was more frequent in patients whose most recent ACEI/ARA therapy was taken <10 h (60%) compared with those who stopped it ≥10 h (46%) before induction (P = 0.02). The adjusted odds ratio for moderate hypotension was 1.74 (95% confidence interval, 1.03-2.93) for those who took their ACEI/ARA therapy <10 h before surgery (P = 0.04). There were no differences between groups in the incidence of severe hypotension, nor was there a difference in the use of vasopressors. During the 31-60 min after induction, the incidence of either moderate (P = 0.43) or severe (P = 0.97) hypotension was similar in the two groups. No differences in postoperative complications were found between groups. In conclusion, discontinuation of ACEI/ARA therapy at least 10 h before anesthesia was associated with a reduced risk of immediate postinduction hypotension.

Original languageEnglish (US)
Pages (from-to)636-644
Number of pages9
JournalAnesthesia and Analgesia
Volume100
Issue number3
DOIs
StatePublished - Mar 2005

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Angiotensins
Angiotensin-Converting Enzyme Inhibitors
Hypotension
Population
Blood Pressure
General Anesthesia
Anesthetics
Therapeutics
Anesthesia
Angiotensin Receptors
Electronic Health Records
Incidence
Comorbidity
Arterial Pressure
Heart Rate
Hemodynamics
Odds Ratio
Confidence Intervals
Interviews

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Comfere, T., Sprung, J., Kumar, M. M., Draper, M., Wilson, D. P., Williams, B. A., ... Warner, D. O. (2005). Angiotensin system inhibitors in a general surgical population. Anesthesia and Analgesia, 100(3), 636-644. https://doi.org/10.1213/01.ANE.0000146521.68059.A1

Angiotensin system inhibitors in a general surgical population. / Comfere, Thomas; Sprung, Juraj; Kumar, Matthew M.; Draper, Myongsu; Wilson, Diana P.; Williams, Brent A.; Danielson, David R.; Liedl, Lavonne; Warner, David Oman.

In: Anesthesia and Analgesia, Vol. 100, No. 3, 03.2005, p. 636-644.

Research output: Contribution to journalArticle

Comfere, T, Sprung, J, Kumar, MM, Draper, M, Wilson, DP, Williams, BA, Danielson, DR, Liedl, L & Warner, DO 2005, 'Angiotensin system inhibitors in a general surgical population', Anesthesia and Analgesia, vol. 100, no. 3, pp. 636-644. https://doi.org/10.1213/01.ANE.0000146521.68059.A1
Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA et al. Angiotensin system inhibitors in a general surgical population. Anesthesia and Analgesia. 2005 Mar;100(3):636-644. https://doi.org/10.1213/01.ANE.0000146521.68059.A1
Comfere, Thomas ; Sprung, Juraj ; Kumar, Matthew M. ; Draper, Myongsu ; Wilson, Diana P. ; Williams, Brent A. ; Danielson, David R. ; Liedl, Lavonne ; Warner, David Oman. / Angiotensin system inhibitors in a general surgical population. In: Anesthesia and Analgesia. 2005 ; Vol. 100, No. 3. pp. 636-644.
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