Would you continue the angiotensin-converting enzyme (ACE) inhibitor on the day of surgery? Why/why not?
Answer:
Major medical societies such as the American College of Cardiology and American Heart Association recommend continuation of ACE inhibitors in the perioperative period. There is no difference in the amount of vasopressor or inotrope requirements during cardiac surgery in those patients who continue ACE inhibitors preoperatively. In fact, ACE inhibitors may help control post-CPB hypertension. Diabetic patients may specifically benefit from receiving ACE inhibitors preoperatively. Patients at risk for vasoplegia or impaired left ventricular function may, however, suffer from intraoperative hypotension.
Reference(s):
- Bhatia M, Arora H, Kumar P. Pro: ACE inhibitors should be continued perioperatively and prior to cardiac surgery. J Cardiothorac Vasc Anesth. 2016;30(3):816-819.
- Disque A, Neelankavil J. Con: ACE inhibitors should be stopped prior to cardiac surgery. J Cardiothorac Vasc Anesth. 2016;30(3):820-822.
- Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(2):2215-2245.
- Kristensen SD, Knuuti J. New ESC/ESA guidelines on noncardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014;35:2344-2345.