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  – 168.52
MEiN – 70 pts

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

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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

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