1
|
Waters CM, Pelczar K, Adlesic EC, Schwartz PJ, Giovannitti JA. ACE-Inhibitor or ARB-Induced Refractory Hypotension Treated With Vasopressin in Patients Undergoing General Anesthesia for Dentistry: Two Case Reports. Anesth Prog 2022; 69:30-35. [PMID: 36223194 PMCID: PMC9552622 DOI: 10.2344/anpr-69-02-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/15/2022] [Indexed: 11/06/2022] Open
Abstract
Two case reports present the use of vasopressin for treating refractory hypotension associated with continued angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to general anesthesia for oral surgery. Both patients were treated in an ambulatory dental surgery clinic and took either their ACEI or ARB medication for hypertension within 24 hours prior to undergoing an intubated general anesthetic. Persistent profound hypotension was encountered intraoperatively that was refractory to treatment with traditional methods. However, the ACEI- or ARB-induced refractory hypotension was successfully managed with the administration of vasopressin.
Collapse
Affiliation(s)
- Caitlin M. Waters
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Kristen Pelczar
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Edward C. Adlesic
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
,Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Paul J. Schwartz
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
,Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Joseph A. Giovannitti
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
2
|
Downing JW, Baysinger CL, Johnson RF, Paschall RL, Shotwell MS. The Effects of Vasopressin and Oxytocin on the Fetoplacental Distal Stem Arteriolar Vascular Resistance of the Dual-Perfused, Single, Isolated, Human Placental Cotyledon. Anesth Analg 2016; 123:698-702. [DOI: 10.1213/ane.0000000000001449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
3
|
Sprung J, Larson KJ, Divekar RD, Butterfield JH, Schwartz LB, Weingarten TN. Refractory intraoperative hypotension with elevated serum tryptase. Asia Pac Allergy 2015; 5:47-50. [PMID: 25653920 PMCID: PMC4313759 DOI: 10.5415/apallergy.2015.5.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/25/2014] [Indexed: 01/16/2023] Open
Abstract
Severe intraoperative hypotension has been reported in patients on angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists. We describe a patient on lisinopril who developed refractory intraoperative hypotension associated with increased serum tryptase level suggesting mast cell activation (allergic reaction). However, allergology workup ruled out an allergic etiology as well as mastocytosis, and hypotension recalcitrant to treatment was attributed to uninterrupted lisinopril therapy. Elevated serum tryptase was attributed to our patient's chronic renal insufficiency.
Collapse
Affiliation(s)
- Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kelly J Larson
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rohit D Divekar
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph H Butterfield
- Department of Internal Medicine, Mayo Clinic Program for the Study of Mast Cell and Eosinophil Disorders, Mayo Clinic, Rochester, MN 55905, USA
| | - Lawrence B Schwartz
- Division of Rheumatology, Allergy & Immunology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | |
Collapse
|
4
|
Doğu B, Öksüz H, Şenoğlu N, Yavuz C, Gişi G. Postoperative Sudden Hypotension Due to Relative Adrenal Insufficiency. Turk J Anaesthesiol Reanim 2014; 42:283-7. [PMID: 27366438 DOI: 10.5152/tjar.2014.33254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/23/2013] [Indexed: 11/22/2022] Open
Abstract
Systemic blood pressure is regulated by three mechanisms: the sympathetic nervous system, the renin-angiotensin system, and the arginine-vasopressin system. Hypotension is a condition that can occur at any stage of management of general anaesthesia, including induction, extubation, and maintenance. Many of the medications used for anaesthesia produce a mild to moderate decrease in systemic vascular resistance (SVR) with a subsequent decrease in arterial blood pressure. Profound and sustained hypotension, however, can have a global impact, resulting in a failure to adequately perfuse systemic capillary networks. The following report describes the case of a 69-year-old man undergoing surgery for total hip replacement who had hypotension that was refractory to fluid administration and inotropic agents at the end of the surgery. In this case study, the role of methylprednisolone therapy in catecholamine-resistant hypotension is also discussed.
Collapse
Affiliation(s)
- Birsen Doğu
- Department of Anaesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Hafize Öksüz
- Department of Anaesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Nimet Şenoğlu
- Department of Anaesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Cengizhan Yavuz
- Department of Anaesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Gökçe Gişi
- Department of Anaesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| |
Collapse
|
5
|
Adlesic EC. Cardiovascular anesthetic complications and treatment in oral surgery. Oral Maxillofac Surg Clin North Am 2013; 25:487-506, vii. [PMID: 23684368 DOI: 10.1016/j.coms.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Perioperative hypertension is a common problem. If hypertension is left untreated in patients at risk, infarctions and stroke are possible. There are limited choices of antihypertensive agents for the office. Aggressive antihypertensive therapy is not indicated because most of the episodes seen in the office are hypertensive urgencies and not emergencies. Hypotension is usually managed by decreasing the depth of anesthesia, intravenous fluids, and then vasopressors, typically ephedrine or phenylephrine. Consider treatment of hypotension whenever the mean arterial pressure decreases less than 60 mm Hg.
Collapse
|
6
|
Multifactorial Model and Treatment Approaches of Refractory Hypotension in a Patient Who Took an ACE Inhibitor the Day of Surgery. Case Rep Anesthesiol 2013; 2013:723815. [PMID: 23662213 PMCID: PMC3639669 DOI: 10.1155/2013/723815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 03/11/2013] [Indexed: 11/18/2022] Open
Abstract
In the field of anesthesiology, there is wide debate on discontinuing angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy the day of noncardiac surgery. Although there have been many studies attributing perioperative hypotension to same-day ACEI and ARB use, there are many additional variables that play a role in perioperative hypotension. Additionally, restoring blood pressure in these patients presents a unique challenge to anesthesiologists. A case report is presented in which a patient took her ACEI the day of surgery and developed refractory hypotension during surgery. The evidence of ACEI use on the day of surgery and development of hypotension is reviewed, and additional variables that contributed to this hypotensive episode are discussed. Lastly, current challenges in restoring blood pressure are presented, and a basic model on treatment approaches for refractory hypotension in the setting of perioperative ACEI use is proposed.
Collapse
|
7
|
Mets B. Management of Hypotension Associated With Angiotensin-Axis Blockade and General Anesthesia Administration. J Cardiothorac Vasc Anesth 2013; 27:156-67. [DOI: 10.1053/j.jvca.2012.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Indexed: 11/11/2022]
|
8
|
Tobias JD, Allee J, Ramachandran V, Groshong T. Clevidipine controls intraoperative blood pressure in an adolescent with renal failure. J Pediatr Pharmacol Ther 2012; 14:144-7. [PMID: 23055902 DOI: 10.5863/1551-6776-14.3.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In pediatric-aged patients, various factors may result in perioperative hypertension including renal failure or insufficiency, volume overload, or other factors that activate the sympathetic nervous system including pain and agitation. Perioperative blood pressure control may be even more difficult to achieve and maintain in patients with pre-existing hypertension. We present a 16-year-old adolescent with renal failure and hypertension who presented for anesthetic care during placement of a peritoneal dialysis catheter. Perioperative blood pressure control was achieved with the administration of clevidipine, an ultra-short acting calcium channel antagonist of the dihydropyridine class. Its role in the perioperative control of blood pressure is discussed.
Collapse
Affiliation(s)
- Joseph D Tobias
- Department of Anesthesiology, University of Missouri, Columbia, Missouri ; Department of Pediatrics, University of Missouri, Columbia, Missouri
| | | | | | | |
Collapse
|
9
|
Meyer T, Tobias JD. Perioperative blood pressure management with clevidipine during coiling of cerebral artery aneurysms. Saudi J Anaesth 2011; 3:83-6. [PMID: 20532109 PMCID: PMC2876934 DOI: 10.4103/1658-354x.57880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The tight control of blood pressure (BP) is mandatory during cerebral aneurysm coiling to minimize abrupt changes in the transmural pressure across the aneurysm and thereby decrease the risk of rupture. Critical times during these procedures when significant BP changes may occur include anesthetic induction, endotracheal intubation, and emergence. Clevidipine is a recently introduced, rapidly acting dihydropyridine calcium channel antagonist. Its rapid metabolism by tissue and plasma esterases results in an effective half-life of 1 to 3 minutes. We present our preliminary experience with the use of clevidipine to control BP during the anesthetic care of three patients undergoing coiling of cerebral aneurysms in the interventional radiology suite.
Collapse
Affiliation(s)
- Thomas Meyer
- Department of Anesthesiology, University of Missouri, Missouri, Colombia
| | | |
Collapse
|
10
|
Abstract
Intraoperative neuromonitoring (IONM) is a relatively recent advance in electromyography (EMG) applied to otolaryngology-head and neck surgery. Its purpose is to allow real-time identification and functional assessment of vulnerable nerves during surgery. The nerves most often monitored in head and neck surgery are the motor branch of the facial nerve (VII), the recurrent or inferior laryngeal nerves (X), the vagus nerve (X), and the spinal accessory nerve (XI), with other cranial lower nerves monitored less frequently. Morbidity from trauma to these nerves is significant and obvious, such as unilateral facial paresis. Although functional restorative surgery is usually considered to repair the effects of such an insult, the importance of preventing nerve injury in head and neck surgery is obvious. This article focuses on the anesthetic considerations pertinent to IONM of peripheral cranial nerves during otolaryngologic-head and neck surgery. The specific modality of IONM is EMG, both spontaneous and evoked.
Collapse
Affiliation(s)
- Francis X Dillon
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
| |
Collapse
|