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.


References:

  • 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 surgery. J 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 opinion. Asian 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 requirements. Br 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 surgery. Anesthesiology 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 bypass. Anesth Analg 1995;80:473-479.

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