Document Detail


Prophylactic vasopressin in patients receiving the angiotensin-converting enzyme inhibitor ramipril undergoing coronary artery bypass graft surgery.
MedLine Citation:
PMID:  19875309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to compare the effects of continuation versus discontinuation of the angiotensin-converting enzyme (ACE) inhibitor ramipril and assess the efficacy of prophylactic vasopressin infusion on hemodynamic stability and vasoactive drug requirements in patients undergoing coronary artery bypass graft (CABG) surgery. DESIGN: A prospective, randomized, double-blinded, single-center clinical study. SETTING: Tertiary care hospital. PARTICIPANTS: Forty-seven patients on the ACE inhibitor ramipril for 6 weeks before undergoing elective primary CABG surgery on cardiopulmonary bypass (CPB). INTERVENTIONS: Patients were randomly divided into 3 groups: group A (n = 16), patients discontinued ramipril 24 hours before surgery; group B (n = 16), patients continued ramipril until the morning of surgery; and group C (n = 15), patients continued ramipril until the morning of surgery and received vasopressin infusion (0.03 U/min) from the onset of rewarming until the hemodynamics were stable without vasopressor agents. The anesthetic technique and conduct of CPB were standardized for all the groups. Hemodynamic parameters and vasoactive drug requirements were recorded for 3 days postoperatively. MEASUREMENTS AND MAIN RESULTS: Patients in group A maintained stable mean arterial pressure (MAP) and systemic vascular resistance (SVR). In group B, MAP and SVR decreased after the induction of anesthesia and remained so throughout surgery (p < 0.05). In group C, MAP and SVR decreased upon the induction of anesthesia (p < 0.05) but normalized after CPB. CONCLUSIONS: Preoperative ACE inhibitor continuation predisposed to hypotension upon the induction of anesthesia and in the post-CPB period. Prophylactic low-dose vasopressin infusion prevented post-CPB hypotension. Low-dose vasopressin can be considered as potential therapy in these patients.
Authors:
Suruchi Hasija; Neeti Makhija; Minati Choudhury; Milind Hote; Sandeep Chauhan; Usha Kiran
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-10-28
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  24     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-05     Completed Date:  2010-11-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  230-8     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiotensin-Converting Enzyme Inhibitors / adverse effects,  therapeutic use*
Blood Pressure / drug effects,  physiology
Coronary Artery Bypass* / methods
Double-Blind Method
Female
Heart Rate / drug effects,  physiology
Humans
Hypotension / chemically induced,  prevention & control
Male
Middle Aged
Prospective Studies
Ramipril / adverse effects,  therapeutic use*
Vasopressins / administration & dosage*
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 11000-17-2/Vasopressins; 87333-19-5/Ramipril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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