title: No consensus on withholding angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before spinal anaesthesia.
abstract: BACKGROUND
  Danish (including Greenland and the Faroe Islands) and international guidelines were reviewed to determine to which extent they recommend the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) before spinal anaesthesia.
  
  
  METHODS
  A total of 50 Danish departments of anaesthesia and 30 societies of anaesthesiology were invited by e-mail to detail their guidelines on pre-anaesthesia ACE inhibitor and ARB use and the number of registered deaths due to hypotension. PubMed was searched for existing guidelines.
  
  
  RESULTS
  Seven of 31 responding departments in Denmark had issued guidelines. None of 11 responding societies except the French had issued guidelines. The French society recommended discontinuation of ACE inhibitors and ARBs for hypotension > 12 hours before surgery, but no discontinuation in case of heart failure. None of the societies reported deaths.
  
  
  CONCLUSIONS
  A minority of the responding Danish departments of anaesthesia and the French Society of Anaesthesiologists have issued guidelines on the use of ACE inhibitors and ARB, but extant literature is scant and equivocal, and no randomized trials have studied either the indications for or the adverse outcome of ACE inhibitors and ARB treatment.
authors.affiliation: Department of Anaesthesia & Surgery, Hospital Sønderjylland, Sønderborg, Denmark. mads.bogebjerg@shs.regionsyddanmark.dk
authors.forename: Mads Konow
authors.initials: MK
authors.lastname: Bøgebjerg
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D003657:Decision Making; D003718:Denmark; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors