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ORIGINAL ARTICLE
Year : 2014  |  Volume : 8  |  Issue : 1  |  Page : 32-35

Effect of pre-operative discontinuation of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists on intra-operative arterial pressures after induction of general anesthesia


Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India

Correspondence Address:
Sunil Rajan
Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0259-1162.128903

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Context: Medical guidelines advise perioperative continuation many antihypertensives, but discontinuing angiotensin antagonists before surgery. Aims: This study is aimed to determine the effect of preoperative discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA) on intra-operative blood pressure after induction of general anesthesia. Settings and Design: The study was a randomized, prospective and double blinded one done in 60 hypertensive patients, receiving these drugs. Materials and Methods: Patients were randomized into two equal groups. In Group A, ACEI or angiotensin II receptor antagonist was stopped the day before surgery, but in Group B it was continued. Anesthetic management was standardized by a study protocol. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured just before induction and after induction at 1 min, 3, 5, 10, 15, 30, 45 and 60 min. Statistical Analysis: Difference between means and difference between two proportions was analyzed using Normal test for means and corresponding P values were calculated. Results: Pre-induction SBP, DBP and MAP were comparable between groups. However when the pre-induction values were compared with subsequent readings at 3, 5, 10, 15, 30, 45 and 60 min, it was found that there was a significant reduction in SBP, DBP and MAP in Group B up to 60 min. Conclusions: Intraoperative hemodynamics can be safely managed when ACEI or ARA are withheld on the day of surgery.


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