Arterial hypotension in myocardial revascularization surgery: influence of angiotensin-converting enzyme inhibitors.
OBJECTIVE
Angiotensin-converting enzyme inhibitors (ACEI) are widely used in hypertension and heart failure. Their prolonged use may lead to hemodynamic instability and hypotension during anesthetic induction. This study aimed at comparing the incidence of hypotension in patients chronically treated and non treated with ACEI, submitted to anesthesia for myocardial revascularization.


METHODS
Participated in this study 50 patients, physical status ASA II, III and IV, who were distributed in two groups: Group 1 - patients treated with ACEI for more than two months. Group 2 - patients not treated with ACEI. Parameters evaluated were mean blood pressure (MBP), heart rate (HR), and analysis of the ST segment in D(II) and V5. Systemic vascular resistance was determined during CPB.


RESULTS
The incidence of arterial hypotension in anesthetized patients under ACEI was higher than in the control group in several anesthetic moments, but was predominant during anesthetic induction. This group needed dopamine for longer periods. From the 26 patients previously treated with ACEI, 23% needed drugs to correct hypotension from induction to CPB, and 19.1% in other anesthetic periods, totaling 42.3%. No control group patient needed drug infusion to increase systemic blood pressure, from induction to CPB. However, 21% of patients in this group needed dopamine or araminol in one or more anesthetic moments.


CONCLUSIONS
In our study, patients treated with ACEI for prolonged periods had a higher incidence of hypotension on anesthetic induction, requiring more drugs to maintain systemic pressure in adequate levels.
Jordão
Míriam Gomes
MG
Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS.
dos Santos
Ari Tadeu Lírio
AT