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Prophylactic vasopressin in patients receiving the angiotensin-converting enzyme inhibitor ramipril undergoing coronary artery bypass graft surgery.
- Source :
-
Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2010 Apr; Vol. 24 (2), pp. 230-8. Date of Electronic Publication: 2009 Oct 28. - Publication Year :
- 2010
-
Abstract
- 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.<br />Design: A prospective, randomized, double-blinded, single-center clinical study.<br />Setting: Tertiary care hospital.<br />Participants: Forty-seven patients on the ACE inhibitor ramipril for 6 weeks before undergoing elective primary CABG surgery on cardiopulmonary bypass (CPB).<br />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.<br />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.<br />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.<br /> (Copyright (c) 2010 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Angiotensin-Converting Enzyme Inhibitors adverse effects
Blood Pressure drug effects
Blood Pressure physiology
Double-Blind Method
Female
Heart Rate drug effects
Heart Rate physiology
Humans
Hypotension chemically induced
Hypotension prevention & control
Male
Middle Aged
Prospective Studies
Ramipril adverse effects
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Coronary Artery Bypass methods
Ramipril therapeutic use
Vasopressins administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8422
- Volume :
- 24
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of cardiothoracic and vascular anesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 19875309
- Full Text :
- https://doi.org/10.1053/j.jvca.2009.08.001