Cardiac Arrest during Total Hip Arthroplasty in a Patient on an Angiotensin Receptor Antagonist
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Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (ARA) are effective and well-tolerated first-line drugs in the therapy of hypertension and, therefore, are frequently encountered in the perioperative setting. Hemodynamic compensation for volume depletion seen in the perioperative period is normally mediated by the renin–angiotensin system, which is blocked by ACEI/ARA. These drugs may contribute to severe hypotension during anesthesia induction and may have contributed to the cardiac arrest seen in this patient. Additional factors such as increased intra-abdominal pressures and respiratory obstructive episodes leading to diminished venous return, as well diuretic use and the fasting state, common in the perioperative orthopedic patient, are likely to have contributed as well. Medication use may be an easily modifiable risk factor for severe hypotension and possible cardiac arrest in the perioperative setting.
- Arora P, Rajagopalam S, Ranjan R, Kolli H, Singh M, Venuto R, Lohr J. Preoperative use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers is associated with increased risk for acute kidney injury after cardiovascular surgery. Clin J Am Soc Nephrol. 2008;5:1266–1273. CrossRef
- Barreras A, Gurk-Turner C. Angiotensin II receptor blockers. Proc (Bayl Univ Med Cent). 2003;1:123–126.
- Brabant SM, Bertrand M, Eyraud D, Darmon PL, Coriat P. The hemodynamic effects of anesthetic induction in vascular surgical patients chronically treated with angiotensin II receptor antagonists. Anesth Analg. 1999;6:1388–1392.
- Brabant SM, Eyraud D, Bertrand M, Coriat P. Refractory hypotension after induction of anesthesia in a patient chronically treated with angiotensin receptor antagonists. Anesth Analg. 1999;4:887–888.
- Butterworth J, Furberg CD. Improving cardiac outcomes after noncardiac surgery. Anesth Analg. 2003;3:613–615. CrossRef
- Cittanova ML, Zubicki A, Savu C, Montalvan C, Nefaa N, Zaier K, Riou B, Coriat P. The chronic inhibition of angiotensin-converting enzyme impairs postoperative renal function. Anesth Analg. 2001;5:1111–1115. CrossRef
- Colson P, Ryckwaert F, Coriat P. Renin angiotensin system antagonists and anesthesia. Anesth Analg. 1999;5:1143–1155. CrossRef
- Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA, Danielson DR, Liedl L, Warner DO. Angiotensin system inhibitors in a general surgical population. Anesth Analg. 2005;3:636–44, table of contents. CrossRef
- Cozanitis DA. The importance of interrupting angiotensin converting enzyme inhibitor treatment before spinal anaesthesia--a controlled case report. Anaesthesiol Reanim. 2004;1:16–18.
- Eyraud D, Mouren S, Teugels K, Bertrand M, Coriat P. Treating anesthesia-induced hypotension by angiotensin II in patients chronically treated with angiotensin-converting enzyme inhibitors. Anesth Analg. 1998;2:259–263.
- Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A, Hempelmann G. The incidence and risk factors for hypotension after spinal anesthesia induction: An analysis with automated data collection. Anesth Analg. 2002;6:1521–9, table of contents.
- Kashihara K. Roles of arterial baroreceptor reflex during bezold-jarisch reflex. Curr Cardiol Rev. 2009;4:263–267. CrossRef
- Kheterpal S, Khodaparast O, Shanks A, O’Reilly M, Tremper KK. Chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy combined with diuretic therapy is associated with increased episodes of hypotension in noncardiac surgery. J Cardiothorac Vasc Anesth. 2008;2:180–186. CrossRef
- Larochelle P, Flack JM, Marbury TC, Sareli P, Krieger EM, Reeves RA. Effects and tolerability of irbesartan versus enalapril in patients with severe hypertension. irbesartan multicenter investigators. Am J Cardiol. 1997;12:1613–1615. CrossRef
- Liu SS, Della Valle AG, Besculides MC, Gaber LK, Memtsoudis SG. Trends in mortality, complications, and demographics for primary hip arthroplasty in the united states. Int Orthop. 2009;3:643–651. CrossRef
- Memtsoudis SG, Della Valle AG, Besculides MC, Gaber L, Laskin R. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty. J Arthroplasty. 2009;4:518–527. CrossRef
- Moser M. Angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and calcium channel blocking agents: A review of potential benefits and possible adverse reactions. J Am Coll Cardiol. 1997;7:1414–1421. CrossRef
- Railton CJ, Wolpin J, Lam-McCulloch J, Belo SE. Renin-angiotensin blockade is associated with increased mortality after vascular surgery. Can J Anaesth. 2010;8:736–744.
- Wijeysundera DN, Beattie WS. Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: A meta-analysis. Anesth Analg. 2003;3:634–641. CrossRef
- Cardiac Arrest during Total Hip Arthroplasty in a Patient on an Angiotensin Receptor Antagonist
HSS Journal ®
Volume 8, Issue 2 , pp 175-183
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- cardiac arrest
- perioperative antihypertensive therapy
- Angiotensin converting enzyme inhibitors
- Bezold –Jarisch reflex
- intra-operative hypotension
- renin angiotensin system (RAS)
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