title: Effect of pre-operative discontinuation of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists on intra-operative arterial pressures after induction of general anesthesia.
abstract: BACKGROUND
  Medical guidelines advise perioperative continuation many antihypertensives, but discontinuing angiotensin antagonists before surgery.
  
  
  OBJECTIVE
  This study is aimed to determine the effect of preoperative discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor antagonists (ARA) on intra-operative blood pressure after induction of general anesthesia.
  
  
  METHODS
  The study was a randomized, prospective and double blinded one done in 60 hypertensive patients, receiving these drugs.
  
  
  METHODS
  Patients were randomized into two equal groups. In Group A, ACEI or angiotensin II receptor antagonist was stopped the day before surgery, but in Group B it was continued. Anesthetic management was standardized by a study protocol. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured just before induction and after induction at 1 min, 3, 5, 10, 15, 30, 45 and 60 min.
  
  
  METHODS
  Difference between means and difference between two proportions was analyzed using Normal test for means and corresponding P values were calculated.
  
  
  RESULTS
  Pre-induction SBP, DBP and MAP were comparable between groups. However when the pre-induction values were compared with subsequent readings at 3, 5, 10, 15, 30, 45 and 60 min, it was found that there was a significant reduction in SBP, DBP and MAP in Group B up to 60 min.
  
  
  CONCLUSIONS
  Intraoperative hemodynamics can be safely managed when ACEI or ARA are withheld on the day of surgery.
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rajgopal
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Sapru
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Jerry
authors.initials: J
authors.lastname: Paul
keywords: Angiotensin II receptor antagonists; angiotensin-converting enzyme inhibitors; general anesthesia; hypotension