title: Hemodynamic effects of anesthesia in patients with ischemic heart failure chronically treated with angiotensin-converting enzyme inhibitors.
abstract: Anesthesia may induce hemodynamic instability in patients treated with angiotensin-converting enzyme inhibitors (ACEIs). To assess the hemodynamic effects of anesthesia in patients treated (n = 9) or not treated (n = 9) with ACEIs for ischemic left ventricle dysfunction after myocardial infarction, we studied 18 patients scheduled for elective coronary artery bypass graft surgery. Induction of anesthesia with fentanyl (5 micrograms/kg), flunitrazepam (30 micrograms/kg), and pancuronium (100 micrograms/kg) was followed by a significant decrease in mean arterial blood pressure in both groups (-18.6% +/- 8.1% in controls and -25.7% +/- 7.8% in ACEI-treated patients, P = 0.01). In controls, cardiac index and systemic vascular resistance were not significantly altered (-11.2% +/- 9.4% and -16.2% +/- 4.6%, respectively, not significant [NS]). In ACEI-treated patients, cardiac index decreased significantly (-27.3% +/- 11.6%, P = 0.01 from baseline and P = 0.03 when compared with controls), and systemic vascular resistance was unchanged (1.0% +/- 18.7%, NS from baseline and P = 0.04 when compared with controls). Two patients from each group experienced a transient severe hypotensive episode. ACEI treatment in patients with infarction-induced myocardial dysfunction does not increase the incidence of severe hypotension after induction of anesthesia.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hôpital Arnaud de Villeneuve, Montpellier, France.
authors.forename: F
authors.initials: F
authors.lastname: Ryckwaert
authors.forename: P
authors.initials: P
authors.lastname: Colson
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000209:etiology / Q000503:physiopathology*; D001026:Coronary Artery Bypass; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D011300:Preoperative Care; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors