OBJECTIVE: The purpose of this study was to compare the effects of continuation versus discontinuation of the angiotensin-converting enzyme (ACE) inhibitor ramipril and assess the efficacy of prophylactic vasopressin infusion on hemodynamic stability and vasoactive drug requirements in patients undergoing coronary artery bypass graft (CABG) surgery. DESIGN: A prospective, randomized, double-blinded, single-center clinical study. SETTING: Tertiary care hospital. PARTICIPANTS: Forty-seven patients on theACE inhibitor ramiprilfor 6 weeks before undergoing elective primary CABG surgery on cardiopulmonary bypass (CPB). INTERVENTIONS: Patients were randomly divided into 3 groups: group A (n = 16), patients discontinued ramipril 24 hours before surgery; group B (n = 16), patients continued ramipril until the morning of surgery; and group C (n = 15), patients continued ramipril until the morning of surgery and received vasopressin infusion (0.03 U/min) from the onset of rewarming until the hemodynamics were stable without vasopressor agents. The anesthetic technique and conduct of CPB were standardized for all the groups. Hemodynamic parameters and vasoactive drug requirements were recorded for 3 days postoperatively. MEASUREMENTS AND MAIN RESULTS: Patients in group A maintained stable mean arterial pressure (MAP) and systemic vascular resistance (SVR). In group B, MAP and SVR decreased after the induction of anesthesia and remained so throughout surgery (p < 0.05). In group C, MAP and SVR decreased upon the induction of anesthesia (p < 0.05) but normalized after CPB. CONCLUSIONS: Preoperative ACE inhibitor continuation predisposed to hypotension upon the induction of anesthesia and in the post-CPB period. Prophylactic low-dose vasopressin infusion prevented post-CPB hypotension. Low-dose vasopressin can be considered as potential therapy in these patients. Copyright (c) 2010 Elsevier Inc. All rights reserved.
RCT Entities:
OBJECTIVE: The purpose of this study was to compare the effects of continuation versus discontinuation of the angiotensin-converting enzyme (ACE) inhibitor ramipril and assess the efficacy of prophylactic vasopressin infusion on hemodynamic stability and vasoactive drug requirements in patients undergoing coronary artery bypass graft (CABG) surgery. DESIGN: A prospective, randomized, double-blinded, single-center clinical study. SETTING: Tertiary care hospital. PARTICIPANTS: Forty-seven patients on the ACE inhibitor ramipril for 6 weeks before undergoing elective primary CABG surgery on cardiopulmonary bypass (CPB). INTERVENTIONS:Patients were randomly divided into 3 groups: group A (n = 16), patients discontinued ramipril 24 hours before surgery; group B (n = 16), patients continued ramipril until the morning of surgery; and group C (n = 15), patients continued ramipril until the morning of surgery and received vasopressin infusion (0.03 U/min) from the onset of rewarming until the hemodynamics were stable without vasopressor agents. The anesthetic technique and conduct of CPB were standardized for all the groups. Hemodynamic parameters and vasoactive drug requirements were recorded for 3 days postoperatively. MEASUREMENTS AND MAIN RESULTS:Patients in group A maintained stable mean arterial pressure (MAP) and systemic vascular resistance (SVR). In group B, MAP and SVR decreased after the induction of anesthesia and remained so throughout surgery (p < 0.05). In group C, MAP and SVR decreased upon the induction of anesthesia (p < 0.05) but normalized after CPB. CONCLUSIONS: Preoperative ACE inhibitor continuation predisposed to hypotension upon the induction of anesthesia and in the post-CPB period. Prophylactic low-dose vasopressin infusion prevented post-CPB hypotension. Low-dose vasopressin can be considered as potential therapy in these patients. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Authors: Gahyun Kim; Young Wan Kim; Jong-Hwan Lee; Chung Su Kim; Hyun-Sung Cho; Sangmin Maria Lee; Young-Tak Lee Journal: Korean J Anesthesiol Date: 2014-01-28
Authors: Michael W Manning; Mary Cooter; Joseph Mathew; John Alexander; Eric Peterson; T Bruce Ferguson; Renato Lopes; Mihai Podgoreanu Journal: Ann Thorac Surg Date: 2017-01-25 Impact factor: 4.330
Authors: J Fassl; H Riha; H Ramakrishna; N Singh; T Wyckoff; C Roscher; J G T Augoustides Journal: HSR Proc Intensive Care Cardiovasc Anesth Date: 2010