Management of hypotension associated with angiotensin-axis blockade and general anesthesia administration

摘要

HYPOTENSION, SOMETIMES REFRACTORY, is a well-recognized phenomenon associated with the administration of general anesthesia in patients who have angiotensin-axis blockade (AAB) because of the administration of either angioten-sin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs). Hypotension in such patients usually occurs within 30 minutes of the induction of anesthesia and is more frequent in patients also receiving diuretics. There is an ongoing debate as to whether ACEIs and ARBs should be discontinued before surgery. Although omitting these agents before general anesthesia may avoid hypotension,3-8'10 some argue that their discontinuation is not required because the associated hypotension is easily treatable and subsequent hypertension may occur periop-eratively requiring antihypertensive therapy.