Chronic Renin-Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery.
The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes.
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy. g.salvetti@int.med.unipi.it.
Guido
G
Salvetti
Unit of Anaesthesia and Reanimation in Obesity Surgery and Diseases of Upper Gut, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Claudio
C
Di Salvo
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Giovanni
G
Ceccarini
Unit of Anaesthesia and Reanimation in Obesity Surgery and Diseases of Upper Gut, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Antonio
A
Abramo
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Paola
P
Fierabracci
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Silvia
S
Magno
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Paolo
P
Piaggi
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Paolo
P
Vitti
Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
Ferruccio
F
Santini
D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007022:Hypotension / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D010865:Pilot Projects; D012084:Renin-Angiotensin System / Q000187:drug effects*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
ACE inhibitors; Anaesthesia; Bariatric surgery; Hypertension; Sartans