Effect of Preoperative Omitting Angiotensin-converting Enzyme Inhibitor on Hemodynamics in Patients Undergoing Off Pump Coronary Artery Bypass Surgery.
10.4097/kjae.2007.52.1.34
- Author:
Yong Kyung LEE
1
;
Sungwon NA
;
Soon Ho NAM
;
Sang Boem NAM
;
Young Keun CHAE
;
Hana SONG
;
Young Lan KWAK
Author Information
1. Department of Anesthesiology and Pain Medicine, Kwandong University College of Medicine, Goyang, Korea.
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
ACE inhibitor;
hemodynamics;
norepinephrine;
off pump coronary artery bypass surgery
- MeSH:
Angiotensin-Converting Enzyme Inhibitors;
Arteries;
Blood Pressure;
Coronary Artery Bypass, Off-Pump*;
Hemodynamics*;
Humans;
Norepinephrine;
Transplants
- From:Korean Journal of Anesthesiology
2007;52(1):34-41
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Angiotensin-converting enzyme inhibitors (ACE-I) have been widely used for cardiac patients. This study investigated the effect of omitting ACE-I medication on hemodynamics during induction of anaesthesia and operation in patients chronically treated with ACE-I undergoing off pump coronary artery bypass graft surgery (OPCAB). METHODS: Sixty patients scheduled for OPCAB were included in this study. Patients not treated with ACE-I were included in control group (Group 1, n = 20). And then, patients treated with ACE-I more than 4 weeks were randomly divided into two groups: continuing group including patients who continued ACE-I medication until the morning of surgery (Group 2, n = 20) and discontinuing group including patients who discontinued ACE-I one day before the surgery (Group 3, n = 20). Norepinephrine (8microgram/ml) was infused when systolic blood pressure decreased below 90 mmHg during induction and operation. Amount of norepinephrine infused and hemodynamic data were recorded. RESULTS: Significantly larger amount of norepinephrine was infused in Group 2 than in other two groups during obtuse marginal artery anastomosis. Total amount of norepinephrine infused during the all coronary anatsomosis was significantly larger in Group 2 than those values in other two groups. CONCLUSIONS: Continuing ACE-I treatment until the morning of surgery significantly increased the use of norepinephrine during the anastomosis. In contrast, there was no significant difference in the use of norepinephrine between Group 1 and Group 3. Discontinuing ACE-I before the surgery may helpful to maintain hemodynamics stable during coronary anastomosis in OPCAB.
