Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000600006
Brazilian Journal of Anesthesiology
Scientific Article

Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório?

Influence of angiotensin-converting enzyme inhibitors on hypotension after anesthetic induction: is the preoperative discontinuation of this drug necessary?

Verônica Vieira da Costa; Alexandre Curvelo Caldas; Luiz Guilherme Nadal Nunes; Paulo Sérgio Siebra Beraldo; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942009000600006 Braz J Anesthesiol, vol.59, n6, p.704-715, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: Tem sido sugerida a suspensão de medicamentos como os inibidores da enzima conversora de angiotensina (IECA) com base em relatos de hipotensão arterial durante a anestesia. Isso pode implicar em maior risco de picos hipertensivos no intraoperatório, com efeitos deletérios para o paciente. O objetivo deste estudo foi avaliar a influência dos IECA utilizados no pré-operatório na ocorrência de hipotensão arterial durante anestesia. MÉTODO: Delineamento tipo caso controle, onde casos foram pacientes que apresentaram hipotensão arterial após indução da anestesia. Como controles foram selecionados pacientes da mesma faixa etária e sexo, submetidos à intervenção cirúrgica no mesmo período dos casos e que não apresentaram hipotensão arterial. As variáveis de interesse: idade, sexo, porte cirúrgico, diagnóstico prévio de hipertensão arterial sistêmica (HAS), uso de IECA, estado físico (ASA), sangramento no intraoperatório, técnica anestésica e tempo cirúrgico. RESULTADOS: 40 pacientes apresentaram hipotensão arterial, num total de 2.179 operações. Desses, 20 usaram IECA no dia da operação. O grupo controle foi composto por 171 pacientes, dos quais 11 usaram IECA. Na análise univariada foi encontrada associação entre hipotensão arterial e idade avançada (p < 0,001), diagnóstico prévio de hipertensão arterial (p < 0,001), uso de IECA (p = 0,006), estado físico do paciente (ASA) (p = 0,006) e porte cirúrgico (p = 0,028). Numa análise estratificada não houve associação de hipotensão arterial com o uso de IECA. Na regressão logística mantiveram associação com a hipotensão arterial, o porte cirúrgico e idade do paciente. CONCLUSÕES: Não foi encontrada associação do uso de IECA e hipotensão arterial durante a anestesia. Os autores consideraram que a orientação de suspender o IECA na véspera da intervenção cirúrgica precisa ser revista. Outros estudos devem ser considerados para confirmar esse resultado.

Palavras-chave

DOENÇAS, DROGAS, PRÉ-ANESTESIA

Abstract

BACKGROUND AND OBJECTIVES: The discontinuation of drugs such as angiotensin-converting enzyme inhibitors (ACE inhibitors) has been suggested based on reports of hypotension during anesthesia. This may imply on a higher risk of intraoperative hypertensive peaks with deleterious consequences for the patient. The objective of the present study was to evaluate the influence of the preoperative use of ACE inhibitors on the development of hypotension during anesthesia. METHODS: This is a case-controlled study of patients who developed hypotension after anesthetic induction. The control group was composed of patients of the same age and gender who underwent surgeries during the same period and who did not develop hypotension. Parameters of interest included: age, gender, size of the surgery, prior diagnosis of hypertension, use of ACE inhibitors, physical status (ASA), intraoperative bleeding, anesthetic technique, and duration of the surgery. RESULTS: In 2,179 surgeries, 40 patients developed hypotension. Twenty of those patients used ACEIs on the day of the surgery. The control group was composed by 171 patients, 11 of which used ACE inhibitors. Univariate analysis showed an association between hypertension and advanced age (p < 0.001), prior diagnosis of hypertension (p < 0.001), use of ACEIs (p = 0.006), physical status (ASA) (p = 0.006), and size of the surgery (p = 0.028). Stratified analysis did not show an association between hypotension and use of ACE inhibitors. On logistic regression, the association between the size of the surgery and the age of the patient and the development of hypotension remained. CONCLUSIONS: We did not observe an association between the use of ACE inhibitors and hypotension during anesthesia. The authors considered that the recommendation to discontinue ACE inhibitors on the day before the surgery should be reviewed. Other studies are necessary to confirm those results.

Keywords

DISEASES, DRUGS, PRE-ANESTHESIA

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