Korean J Anesthesiol.  2008 Sep;55(3):363-366. 10.4097/kjae.2008.55.3.363.

Intra-operative refractory hypotension in patient chronically treated with renin-angiotensin system antagonists: A case report

• Kim ES
• Kwon OK
• No HC
• Kim JE

• KMID: 1764029
• DOI: http://doi.org/10.4097/kjae.2008.55.3.363

Abstract

Chronic treatment with renin-angiotensin system antagonists frequently causes deleterious hypotension during anesthesia. We present a case of marked intra-operative refractory hypotension in a 61-year-old male patient undergoing elective total thyroidectomy. He has been chronically treated for hypertension with angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and atenolol, which were taken until the morning of surgery. After induction of anesthesia, marked hypotension which was refractory to fluid therapy occurred and did not respond to ephedrine administration. After continuous norepinephrine infusion, blood pressure increased and remained stable during the anesthesia period. Before extubation, norepinephrine was discontinued and recovery took place without complications. We discuss the anesthetic implication of chronic renin-angiotensin system antagonists treatment and intra-operative hemodynamic instability.

Keyword

angiotensin-converting enzyme inhibitors; angiotensin II receptor antagonists; refractory hypotension

MeSH Terms

Anesthesia
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Atenolol
Blood Pressure
Ephedrine
Fluid Therapy
Hemodynamics
Humans
Hypertension
Hypogonadism
Hypotension
Male
Middle Aged
Mitochondrial Diseases
Norepinephrine
Ophthalmoplegia
Renin-Angiotensin System
Thyroidectomy
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Atenolol
Ephedrine
Hypogonadism
Mitochondrial Diseases
Norepinephrine
Ophthalmoplegia