Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2010, vol. 19, nr 3, May-June, p. 329–336

Publication type: original article

Language: English

The Influence of Chronic and Short-Term Treatment with Angiotensin-Converting Enzyme Inhibitor on Hemodynamics During Induction of General Anesthesia in Patients Undergoing Maxillofacial Surgery

Wpływ inhibitora – konwertazy angiotensyny stosowanego w przewlekłej i krótkotrwałej terapii na wybrane wskaźniki hemodynamiczne podczas wprowadzenia do znieczulenia ogólnego pacjentów poddanych zabiegom naprawczym po urazach twarzoczaszki

Małgorzata Malinowska-Zaprzałka1,, Marzena Wojewódzka-Żelezniakowicz2,, Jerzy R. Ładny2,, Ewa Chabielska3,

1 Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Poland

2 Department of Emergency and Disaster Medicine, Medical University of Bialystok, Poland

3 Biopharmacy Department, Medical University of Bialystok, Poland

Abstract

Background. There is still no agreement whether antihypertensive treatment with ACE-I should be continued until the day of surgery because of risk of perioperative hypotension. Moreover, non-treated hypertension is also a major risk of complications during anesthesia, especially ischaemic episodes.
Objectives. The aim of the study was to compare short-term versus chronic treatment effects of ACE-I enalapril on some hemodynamic (blood pressure and heart rate) parameters during the induction of general anesthesia.
Material and Methods. The authors compared systolic and diastolic blood pressure as well as heart rate during induction in three groups of patients (n = 152) scheduled for maxillofacial trauma surgery. Group A (n = 48) was chronically treated with ACE-I enalapril, group B (n = 54) received short term treatment. Group C (50) consisted of normotensive patients.
Results. The authors have determined that short-term (3–4 doses) treatment of patients with moderate hypertension not previously treated with enalapril allows the successful reduction of high systolic and diastolic blood pressures (SBP) – from 174 ± 18 to 148 ± 13 mm Hg and DBP from 112 ± 11 to 83 ± 14 mm Hg – until the day of surgery and induces lower values of systolic blood pressure (SBP) during the induction period of general anesthesia than does chronic treatment. The authors also confirmed the mild hypotensive effect of induction of anesthesia in patients chronically (for at least 6 months) treated with enalapril.
Conclusion. These findings suggest that interruption of treatment before anesthesia is not necessary in hypertensive chronic ACE-I treated patients. Short-term treatment with ACE-I in hypertensive patients allows the successful reduction of high blood pressure and improves the level of safety during induction of anesthesia for maxillofacial trauma surgery.

Streszczenie

Wprowadzenie. Wiele kontrowersji budzi kontynuowanie leczenia nadciśnienia tętniczego inhibitorami konwertazy angiotensyny (ACE-I) do dnia zabiegu chirurgicznego z uwagi na niebezpieczeństwo okołooperacyjnego spadku ciśnienia tętniczego. Nieleczone nadciśnienie tętnicze stanowi natomiast poważne ryzyko powikłań podczas znieczulenia ogólnego, co może prowadzić do epizodów niedokrwienia mięśnia sercowego.
Cel pracy. Porównanie wpływu enalaprylu stosowanego w przewlekłej i krótkotrwałej terapii na niektóre wskaźniki hemodynamiczne (ciśnienie tętnicze i czynność serca) podczas wprowadzenia do znieczulenia ogólnego.
Materiał i metody. Badaniami objęto 152 pacjentów poddanych zabiegom naprawczym po urazach twarzoczaszki. Oceniano wartości skurczowego i rozkurczowego ciśnienia tętniczego oraz częstość akcji serca w trzech grupach chorych podczas wprowadzenia do znieczulenia. Grupę A (n = 48) stanowili pacjenci z przewlekle leczonym nadciśnieniem, grupę B (n = 54) chorzy leczeni krótkotrwale (3–4 dawki), a grupę kontrolną (n = 50) stanowili pacjenci z prawidłowym ciśnieniem tętniczym.
Wyniki. Wykazano, że krótkotrwałe leczenie enalaprylem umiarkowanego nadciśnienia tętniczego pozwala skutecznie obniżyć zarówno skurczowe (174 ± 18 vs 148 ± 13 mm Hg), jak i rozkurczowe (112 ± 11 vs 83 ± 14 mm Hg) ciśnienie tętnicze oraz wywołuje niższe wartości ciśnienia podczas wprowadzenia do znieczulenia niż w grupie chorych leczonych przewlekle. Potwierdzono także umiarkowane działanie hipotensyjne ACE-I podczas wprowadzenia do znieczulenia ogólnego w grupie pacjentów leczonych przewlekle.
Wnioski. Wyniki sugerują, że przerwanie leczenia ACE-I pacjentów z nadciśnieniem nie jest konieczne przed zabiegiem chirurgicznym naprawczym po urazach twarzoczaszki. Już krótkotrwałe przygotowanie tymi lekami pacjentów z umiarkowanym nadciśnieniem pozwala obniżyć jego wartości w dniu zabiegu chirurgicznego i podczas znieczulenia do zabiegów naprawczych po urazach twarzoczaszki, poprawiając bezpieczeństwo pacjenta.

Key words

general anesthesia, ACE-I, hemodynamic response

Słowa kluczowe

znieczulenie ogólne, ACE-I, odpowiedź hemodynamiczna

References (26)

  1. Sear JW, Jewkes C, Tellez J-C, Foex P: Does the choice of antihypertensive therapy influence haemodynamic responses to induction, laryngoscopy and intubation? Br J Anaest 1994, 73, 303–308.
  2. Coriat P, Richer C, Douraki T: Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994, 81, 299–307.
  3. Ullman J: Influence of neurohumoral blockade on heart rate and blood pressure responses to haemorrhage in isoflurane anesthetized animals. Acta Physiol Scand 2000, 169, 1890–1940.
  4. Licker M, Neidhart P, Lustenberger S: Long-term angiotensin-converting enzyme inhibitor treatment attenuates adrenergic responsiveness without altering hemodynamic control in patients undergoing cardiac surgery. Anesthesiology 1996, 84, 789–800.
  5. Colson P: Angiotensin-converting enzyme inhibitors in cardiovascular anesthesia. J Cardiothor Vasc Anesth 1993, 7, 734–742.
  6. Ullman J: Vasopressin and angiotensin II in blood pressure control during isoflurane anesthesia in rats. Acta Anesthesiol Scand 1999, 43, 860–865.
  7. Ullman JE, Hjelmqvist H, Rundgren M, Leksell LG: Hemodynamic effects of vasopressin antagonism and angiotensin I converting enzyme inhibition during halothane anesthesia in sheep. Acta Anesthesiol Scand 1992, 36, 132–137.
  8. Varon J, Marik PE: Perioperative hypertension management. Vasc Health Risk Manag 2008, 4, 615–627.
  9. Wallner T, Preis C, Mayer N: Cardiac medication in the perioperative period. Acta Anesthesiol Scand 1997, 111, 22–28.
  10. Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA, Danielson DR, Liedl L, Warner DO: Angiotensin system inhibitore in a general surgical population. Anesth Analg 2005, 100, 636–644.
  11. Eyraud D, Mouren S, Teugels K, Bertrand M, Coriat P: Treating anesthesia-induced hypotension by angiotensin II in patients chronically treated with angiotensin-converting enzyme inhibitors. Anesth Analg 1998, 86, 259–263.
  12. Kwella N, Kasperczyk J, Araszkiewicz A, Koroll: The influence of chronic treatment with angiotensin converting enzyme inhibitors on blood pressure parameters during general anesthesia in laryngological surgery. Nowiny Lekarskie 2000, 69, 251–259.
  13. Behnia R, Molteni A, Igić R: Angiotensin-converting enzyme inhibitors: mechanisms of action and implications in anesthesia practice. Curr Pharm Des 2003, 9, 763–776.
  14. Mangano DT: Cardiovascular morbidity association with surgery: perspectives and new findings. Ann Card Anaesth 1998, 1, 5–40.
  15. Licker M, Mortel DR: Inhibitors of the rennin angiotensin system: implications for the anaesthesiologist. Curr Opin Anaesthesiol 1998, 11, 321–326.
  16. Colson P, Ribstein J, Mimran A, Grolleau D, Chaptal PA, Roquefeuil B: Effect of angiotensin-converting enzyme inhibition on blood pressure and renal function during open heart surgery. Anesthesiology 1990, 72, 23–27.
  17. Yates AP, Hunter DN: Anesthesia and angiotensin-converting enzyme inhibitors. The effect of enalapril on perioperative cardiovascular stability. Anaesthesia 1988, 43, 935–938.
  18. Adamska-Dyniewska H, Ptaszyński W: Blood pressure variability and smoothness index after 6 antihypertensive drugs. Arterial Hypertens 2000, 4, 181–186.
  19. Falkenhahn M, Gohlke P, Paul M, Stoll M, Unger T: The renin-angiotensin system in the heart and vascular wall: new therapeutic aspects J Cardiovasc Pharmacol 1994, 24, S6–13.
  20. Colson P, Saussine M, Seguin JR: Hemodynamic effects of anesthesia in patients chronically treated with angiotensinconverting enzyme inhibitors. Anesth Analg 1992, 74, 805–808.
  21. Brabant SM, Bertrand M, Eyraud D, Darmon PL, Coriat P: The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg 1999, 89, 1388–1392.
  22. Bendel S, Ruokonen E, Pölönen P, Uusaro A: Propofol causes more hypotension than etomidate in patients with severe aortic stenosis: a double-blind, randomized study comparing propofol and etomidate. Acta Anaesthesiol Scand 2007, 51, 284–289.
  23. Reich DL, Hossain S, Krol M, Baez B, Patel P, Bernstein A, Bodian CA: Predictors of hypotension after induction of general anesthesia. Anesth Analg 2005, 10, 622–628.
  24. Malinowska-Zaprzałka M, Wojewódzka M, Dryl D, Grabowska SZ, Chabielska E: Hemodynamic effect of propofol in enalapril-treated hypertensive patients during induction of general anesthesia. Pharmacol Rep 2005, 57, 675–678.
  25. Kheterpal S, Khodaparast O, Shanks A, OReilly M, Tremper KK: Chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery. J Cardiothorac Vasc Anesth 2008, 22, 180–186.
  26. Slogoff S, Keats AS: Randomized trial of primary anesthetic agents on outcome of coronary artery bypass operations. Anesthesiology 1989, 70, 179–188.