engleski

Angiotensin-converting enzyme inhibitors and the influence of the fluid replacement during spinal anaesthesia

Background and aims. Volume depletion and extended sympathetic blockade during spinal anaesthesia (SA) in angiotensin-converting enzyme inhibitors (ACEI) treated patients, may result in reduced vascular capacitance, decreased venous return, reduced cardiac output and severe hypotension (1)(2). The study investigates the influence of inter-operative fluid replacement on MAP regulation in ACEI-treated patients, 12 hours before SA. Methods. Ninety-eight patients (52-82 age, bough gender, ASA I/III status) scheduled for total or partial hip replacement under SA were included in the study. Fifty-five were hypertonics (56%) and 43(44%) normotonics (Group N). Eighteen (18%) patients with AH were long-term treated with one of ACEI drug (Group ACEI), 17(17%) with calcium channel blocker (Group CCB), 11(11%) had combination of ACEI and CCB (Group ACEI+CCB) and 9 never taken any therapy (Group W). All patients received 10 mlkg-1 of electrolyte solution 30 min before and 5 mlkg-1h-1 during spinal anaesthesia. If the blood pressure fell below 20% of the MAP baseline colloid was added. Non-invasive MAP was recorded continually. Results. The blood loss during surgery was 11-19 mlkg-1m-2 or 321-505 ml and did not differ between groups (P=0.2328). Maximal intra-operative MAP decrease of 17-22% from the baseline occurred in all groups (P=0.0154) but without differences between them (P=0.8498). Although the total intra-operative fluid replacement was almost equal in ACEI=72+/-17 mlkg-1m2, 1803+/-527 ml ; ACEI+CCB=66+/-6, 1733+/-452 ml ; W=72+/-12, 1688+/-416 ml and N group=67+/-9, 1624+/-392 ml, except less intake in CCB group=57+/-14 mlkg-1m2, 1538+/-686 ml (P=0.0034), maintenance of optimal mean MAP during SA (94-100 mmHg, 6-10% less than baseline)(P=0.1216) required significant inter-operative intake of 35% colloid replacement in ACEI group (CCB 15%, ACEI+CCB 16%, W 21%, N 16%)(P=0.0262). Conclusion. Colloid replacement in addition to crystalloids 1:3, improve good haemodynamic regulation of MAP in ACEI treated patients 12 hours before SA without the need of vasoconstrictor drugs during SA. References. 1) Adorisio R, De Luca L, Rossi J et al. Pharmacological treatment of chronic heart failure. Heart Failure Reviews. 2006 ; 11(2): 109-123. 2) Cozanitis DA. The importance of interrupting angiotensin converting enzyme inhibitor treatment before spinal anaesthesia--a controlled case report. Anaesthesiol Reanim. 2004 ; 29(1):16-8.

angiotensin-converting enzyme inhibitor; spinal anaesthesia

DOI: 10.1016/j.rapm.2007.06.076