Korean J Anesthesiol.  2004 Nov;47(5):681-686. 10.4097/kjae.2004.47.5.681.

Effect of Preoperative Angiotensin-Converting Enzyme Inhibitor on Hemodynamics and Vasoconstrictor Requirements in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

• Lee YK
• Bai SJ
• Oh YJ
• Kim JY
• Kim SH
• Kim SH
• Kwak YL

• KMID: 2236671
• DOI: http://doi.org/10.4097/kjae.2004.47.5.681

Abstract

BACKGROUND: This study examined the effect of chronic preoperative ACEI treatment on hemodynamics and the amount of vasoconstrictor used to maintain mean arterial pressure (MAP) during off-pump coronary artery bypass surgery (OPCAB)
METHODS
Sixty patients undergoing OPCAB were divided into two groups: ACEI group, in which patients were treated with ACEI preoperatively (n = 30) and control group, in which patients were not treated with ACEI preoperatively (n = 30). Norepinephrine was infused when MAP decreased below 70 mmHg during operation. Hemodynamic variables and amount of norepinephrine infused were obtained during pericardiotomy and during the anastomosis of each coronary artery including left anterior descending artery (LAD), obtuse marginal artery (OM) of left circumflex coronary artery, and posterior descending artery (PDA) of right coronary artery.
RESULTS
During LAD, OM, and PDA anastomosis, cardiac index and mixed venous oxygen saturation were decreased and central venous pressure and systemic vascular resistance index were increased significantly in both group. There was no significant difference in hemodynamic variables, including MAP, between two groups during all study period. During OM anastomosis, amount of norepinephrine infused to maintain MAP was significantly greater in ACEI group than in control group
CONCLUSIONS
Preoperative treatment with ACEI significantly increased amount of vasoconstrictor used to maintain target MAP during OM anastomosis, which has been known as hemodynamically unstable period during OPCAB, and cautious management is required to maintain MAP.

Keyword

ACE inhibitor; hemodynamics; norepinephrine; off pump coronary artery bypass surgery

MeSH Terms

Arterial Pressure
Arteries
Central Venous Pressure
Coronary Artery Bypass, Off-Pump*
Coronary Vessels
Hemodynamics*
Humans
Norepinephrine
Oxygen
Pericardiectomy
Vascular Resistance
Norepinephrine
Oxygen