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Chronic Renin–Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery

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Abstract

The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin–angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m2) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes.

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Acknowledgments

The authors declare the absence of any conflict of interest related to this manuscript.

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no competing interests.

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We have no support or funding to report.

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Authors and Affiliations

  1. Obesity Centre at the Endocrinology Unit, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy

    Guido Salvetti, Giovanni Ceccarini, Paola Fierabracci, Silvia Magno, Paolo Piaggi, Paolo Vitti & Ferruccio Santini

  2. Unit of Anaesthesia and Reanimation in Obesity Surgery and Diseases of Upper Gut, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy

    Claudio Di Salvo & Antonio Abramo

Authors
  1. Guido Salvetti
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  2. Claudio Di Salvo
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  3. Giovanni Ceccarini
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  4. Antonio Abramo
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  5. Paola Fierabracci
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  6. Silvia Magno
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  7. Paolo Piaggi
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  8. Paolo Vitti
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  9. Ferruccio Santini
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Correspondence to Guido Salvetti.

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Salvetti, G., Di Salvo, C., Ceccarini, G. et al. Chronic Renin–Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery. OBES SURG 26, 1303–1307 (2016). https://doi.org/10.1007/s11695-015-1862-9

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  • DOI: https://doi.org/10.1007/s11695-015-1862-9

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