Arterial Stiffness Predicts General Anesthesia-Induced Vasopressor-Resistant Hypotension in Patients Taking Angiotensin-Converting Enzyme Inhibitors

Kenichi Ueda; David M. Janiczek; Darren P. Casey

doi:10.1053/j.jvca.2020.08.040

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Arterial Stiffness Predicts General Anesthesia-Induced Vasopressor-Resistant Hypotension in Patients Taking Angiotensin-Converting Enzyme Inhibitors

Journal article

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Arterial Stiffness Predicts General Anesthesia-Induced Vasopressor-Resistant Hypotension in Patients Taking Angiotensin-Converting Enzyme Inhibitors

Kenichi Ueda, David M. Janiczek and Darren P. Casey

Journal of cardiothoracic and vascular anesthesia, Vol.35(1), pp.73-80

01/01/2021

DOI: 10.1053/j.jvca.2020.08.040

PMCID: PMC8528715

PMID: 32921603

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https://www.ncbi.nlm.nih.gov/pmc/articles/8528715View

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Abstract

Objectives: Patients chronically treated with angiotensin-converting enzyme inhibitors (ACEIs) may develop hypotension after induction of general anesthesia. A fraction of these patients are resistant to therapeutic doses of vasopressors, which poses serious concerns for hemodynamic management. The authors hypothesized that the patients who develop refractory hypotension, compared with those who do not, show lower central arterial stiffness due to the profound effect of ACEIs. Design: Prospective observational study. Setting: Single tertiary center. Interventions: Fifty surgical patients chronically treated with ACEIs were enrolled. Prior to surgery, all the patients had central arterial stiffness assessment measured by carotid-femoral pulse-wave velocity. Patients were categorized into 2 groups according to the systolic blood pressure response during the first 10 minutes after induction of general anesthesia: a vasopressor-resistant hypotension group requiring more than 200 mu g phenylephrine, or a control group requiring no more than 200 mu g of phenylephrine to maintain systolic blood pressure above 90 mmHg during the study period. Measurements and Main Results: Carotid-femoral pulse-wave velocity was significantly lower in the vasopressor-resistant hypotension group compared to the control group (7.6 [7.2-8.3] m/s v 9.9 [8.7-12.0] m/s, p = 0.001 [Hodges-Lehman median difference 2.2, 95% confidence interval = 1.1-4.4]). Conclusion: These findings suggested that preoperative measurement of carotid-femoral pulse-wave velocity in patients chronically treated with ACEIs could help identify patients at increased risk of developing hypotension refractory to vasopressors after induction of general anesthesia. (C) 2020 Elsevier Inc. All rights reserved.

Anesthesiology

Cardiac & Cardiovascular Systems

Cardiovascular System & Cardiology

Life Sciences & Biomedicine

Peripheral Vascular Disease

Respiratory System

Science & Technology

Details

Title: Subtitle: Arterial Stiffness Predicts General Anesthesia-Induced Vasopressor-Resistant Hypotension in Patients Taking Angiotensin-Converting Enzyme Inhibitors
Creators: Kenichi Ueda - Roy J. and Lucille A. Carver College of Medicine
David M. Janiczek - University of Illinois Chicago
Darren P. Casey - Roy J. and Lucille A. Carver College of Medicine
Resource Type: Journal article
Publication Details: Journal of cardiothoracic and vascular anesthesia, Vol.35(1), pp.73-80
DOI: 10.1053/j.jvca.2020.08.040
PMID: 32921603
PMCID: PMC8528715
NLM abbreviation: J Cardiothorac Vasc Anesth
ISSN: 1053-0770
eISSN: 1532-8422
Publisher: Elsevier
Number of pages: 8
Grant note: UL1 TR002537 / NCATS NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
Language: English
Date published: 01/01/2021
Academic Unit: Anesthesia; Physical Therapy and Rehabilitation Science; Fraternal Order of Eagles Diabetes Research Center
Record Identifier: 9984295052302771

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