Biomaterial Database

[Interferences between angiotensin-converting enzyme inhibitors and spinal anesthesia]. 1994

P Coriat

Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris.

To determine whether angiotensine converting enzyme inhibition (ACEI) therapy should be continued up to the time of the surgical procedure, a standard practice for other modern antihypertensive agents, it should be known whether stopping the treatment does or does not lead to a hypertensive episode before surgery or at intubation and whether continuing treatment is or is not associated with an unacceptable fall in blood pressure at induction. Data from the literature obtained in patients chronically treated for essential hypertension with captopril or enalapril demonstrate that withdrawal of ACEI therapy before surgery does not result in a higher incidence of hypertensive episodes both preoperatively and at intubation. In contrast, an increased need for ephedrine to maintain blood pressure at induction is observed in patients who receive ACEI together with their premedication. This exaggerated hypotensive response to induction is in agreement with previous studies in anaesthetized subjects which have shown that angiotensin II contributes to hemodynamic regulation during general and epidural anaesthesia. It might also be the consequence of the specific effects of ACEI therapy on the loading conditions of the heart and/or the autonomic nervous system. It must be emphasized that both ACEIs and epidural anaesthesia dilate large arteries as capacitance vessels and increase vagal tone. The decreased tone in capacitance vessels accentuates the drops in blood pressure provoked by general or epidural anaesthesia through an increase in blood pooling at the expense of cardiac filling. This mechanism is enhanced by the presence of either a preoperative hypovolemia or a disturbed left ventricular diastolic function, which are two abnormalities frequently seen in hypertensive vascular surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)

UI	MeSH Term	Description	Entries
D007022	Hypotension	Abnormally low BLOOD PRESSURE that can result in inadequate blood flow to the brain and other vital organs. Common symptom is DIZZINESS but greater negative impacts on the body occur when there is prolonged depravation of oxygen and nutrients.	Blood Pressure, Low,Hypotension, Vascular,Low Blood Pressure,Vascular Hypotension
D007431	Intraoperative Complications	Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.	Peroperative Complications,Surgical Injuries,Complication, Intraoperative,Complication, Peroperative,Injuries, Surgical,Complications, Intraoperative,Complications, Peroperative,Injury, Surgical,Intraoperative Complication,Peroperative Complication,Surgical Injury
D004347	Drug Interactions	The action of a drug that may affect the activity, metabolism, or toxicity of another drug.	Drug Interaction,Interaction, Drug,Interactions, Drug
D006439	Hemodynamics	The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM.	Hemodynamic
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000767	Anesthesia, Epidural	Procedure in which an anesthetic is injected into the epidural space.	Anesthesia, Extradural,Anesthesia, Peridural,Epidural Anesthesia,Anesthesias, Epidural,Anesthesias, Extradural,Anesthesias, Peridural,Epidural Anesthesias,Extradural Anesthesia,Extradural Anesthesias,Peridural Anesthesia,Peridural Anesthesias
D000775	Anesthesia, Spinal	Procedure in which an anesthetic is injected directly into the spinal cord.	Anesthesias, Spinal,Spinal Anesthesia,Spinal Anesthesias
D000779	Anesthetics, Local	Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate.	Anesthetics, Conduction-Blocking,Conduction-Blocking Anesthetics,Local Anesthetic,Anesthetics, Topical,Anesthetic, Local,Anesthetics, Conduction Blocking,Conduction Blocking Anesthetics,Local Anesthetics,Topical Anesthetics
D000806	Angiotensin-Converting Enzyme Inhibitors	A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility.	ACE Inhibitor,ACE Inhibitors,Angiotensin Converting Enzyme Inhibitor,Angiotensin I-Converting Enzyme Inhibitor,Angiotensin-Converting Enzyme Inhibitor,Kininase II Inhibitor,Kininase II Inhibitors,Angiotensin I-Converting Enzyme Inhibitors,Angiotensin-Converting Enzyme Antagonists,Antagonists, Angiotensin-Converting Enzyme,Antagonists, Kininase II,Inhibitors, ACE,Inhibitors, Angiotensin-Converting Enzyme,Inhibitors, Kininase II,Kininase II Antagonists,Angiotensin Converting Enzyme Antagonists,Angiotensin Converting Enzyme Inhibitors,Angiotensin I Converting Enzyme Inhibitor,Angiotensin I Converting Enzyme Inhibitors,Antagonists, Angiotensin Converting Enzyme,Enzyme Antagonists, Angiotensin-Converting,Enzyme Inhibitor, Angiotensin-Converting,Enzyme Inhibitors, Angiotensin-Converting,II Inhibitor, Kininase,Inhibitor, ACE,Inhibitor, Angiotensin-Converting Enzyme,Inhibitor, Kininase II,Inhibitors, Angiotensin Converting Enzyme