Thursday, August 7, 2014

Q: Which drug is found to be associated with Vasoplegia Syndrome in post cardiac surgery patients?

Answer: ACE inhibitors and ARBs

Though there is a weak evidence, but many reports have suggested that preoperative administration of ACEI/ARBs in patients undergoing cardiac surgery contributes to lowering of SVR (vasoplegia syndrome) postoperatively. It is also suggested, if possible to hold ACEI/ARBs 24 hours before cardiac surgery to avoid postoperative vasodilation.


  • Lee YK
  • Na SW
  • Kwak YL
  • Nam SB - 
  • Effect of pre-operative angiotensin-converting enzyme inhibitors on haemodynamic parameters and vasoconstrictor requirements in patients undergoing off-pump coronary artery bypass surgeryJ Int Med Res 2005;33:693-702.

    1. Devbhandari MP
    2. Balasubramanian SK
    3. Codispoti M
    4. Nzewi OC
    5. Prasad SU
    .Preoperative angiotensin-converting enzyme inhibition can cause severe post CPB vasodilation – current UK opinionAsian Cardiovasc Thorac Ann 2004;12:346-349.

    1. Bertrand M
    2. Godet G
    3. Meersschaert K
    4. Brun L
    5. Salcedo E
    6. Coriat P
    Should the angiotensin II antagonists be discontinued before surgery? Anesth Analg2001;92:26-30.

    1. Pigott DW
    2. Nagle C
    3. Allman K
    4. Westaby S
    5. Evans RD
    Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirementsBr J Anaesth 1999;83:715-720.

    1. Licker M
    2. Neidhart P
    3. Lustenberger S
    4. Valloton MB
    5. Kalonji T
    6. Fathi M
    7. Morel DR
    .Long-term angiotensin-converting enzyme inhibitor treatment attenuates adrenergic responsiveness without altering hemodynamic control in patients undergoing cardiac surgeryAnesthesiology 1996;84:789-800.

    1. Tuman KJ
    2. McCarthy RJ
    3. O'Connor CJ
    4. Holm WE
    5. Ivankovich AD
    Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypassAnesth Analg 1995;80:473-479.

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