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Canadian Journal of Anesthesia

, Volume 53, Issue 10, pp 994–1003 | Cite as

Brief review: Angiotensin converting enzyme inhibitors and angioedema: anesthetic implications

  • Putul Sarkar
  • Grainne Nicholson
  • George Hall
Article

Abstract

Purpose

Angiotensin converting enzyme inhibitors (ACEIs) are a group of drugs used to treat hypertension and heart failure, with additional benefits, such as cardiovascular and renal protection, in patients with diabetes. However, angioedema as a complication of ACEI therapy is under-recognized. As there are important implications for anesthesiologists and emergency medicine physicians, a review was undertaken to document the scope of the problem of ACEI-induced angioedema.

Methods

A review of the published literature (identified by searching Medline, EMBASE and CINAHL) was undertaken, addressing the clinical uses of ACEIs and the incidence, risk factors, pathophysiology, clinical presentation and management of angioedema associated with the use of these drugs.

Principal findings

The incidence of ACEI related angioedema has increased from 0.1-0.2% to 1% over the last decade. Patients who are receiving ACEIs are predisposed to developing angioedema which may be triggered by trauma, airway instrumentation, infection, and irritant fumes, particularly in those who are at increased risk. Cases of acute facial and airway oedema, due to ACEI drug administration, may be misdiagnosed as an anaphylactic reaction, and the association with ACEIs may be ignored. Some cases of intraoperative and postoperative airway edema may be precipitated by airway instrumentation in patients receiving ACEI drugs. The severity of airway compromise ranges from mild facial edema to severe laryngeal or subglottic edema which may prove life-threatening.

Conclusion

In view of the widespread clinical indications and ever-increasing use of ACEI drugs, the potentially life-threatening adverse reaction of ACEI-associated angioedema, and its treatment, must be recognized by anesthesiologists and all clinicians involved in airway management.

Keywords

Diabetic Nephropathy Angiotensin Converting Enzyme Angioedema Angioneurotic Edema Airway Intervention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Revue sommaire sur les implications anesthésiques de l’œdème de Quincke et des inhibiteurs de l’enzyme de conversion de l’ngiotensine

Résumé

Objectif

Les inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) sont utilisés contre l’hypertension et l’insuffisance cardiaque et aussi pour la protection cardiovasculaire et rénale, chez les patients diabétiques. L’œdème de Quincke est toutefois peu connu comme complication de l’usage des IECA. Cette situation ayant des répercussions sur le travail des anesthésiologistes et des urgentistes, une revue a été réalisée pour montrer l’étendue du problème de l’œdème de Quincke induit par l’IECA.

Méthode

Une revue des articles publiés (découverts dans Medline, EMBASE et CINAHL) a été faite en abordant les usages cliniques des IECA, l’incidence, les facteurs de risque, la physiopathologie, la présentation et le traitement cliniques de l’œdème de Quincke associés à ces médicaments.

Constatations principales

L’incidence d’œdème de Quincke relié aux IECA est passée 0,1–0,2% à 1 % pendant la dernière décennie. Les patients qui prennent des IECA sont prédisposés à l’œdème de Quincke qui peut être déclenché par un traumatisme, une exploration instrumentale, une infection et des émanations irritantes, surtout chez ceux qui sont à haut risque. L’œdème aigu du visage et des voies aériennes peut être diagnostiqué à tort comme une réaction anaphylactique et l’association avec les IECA restée inconnue. L’œdème peropératoire et postopératoire des voies aériennes peut dépendre de l’utilisation d’instruments dans les voies aériennes. La sévérité de l’atteinte peut être un léger œdème facial jusqu’à un œdème laryngé ou sous-glottique important et même très grave.

Conclusion

Dans l’optique des indications cliniques largement répandues, et en augmentation constante, de l’usage des IECA, la réaction indésirable et possiblement grave qu’est l’œdème de Quincke, et son traitement, doivent être connus des anesthésiologistes et de tous les cliniciens concernés par le contrôle des voies aériennes.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  1. 1.Department of Anaesthesia and Intensive Care MedicineSt George’s Hospital Medical SchoolLondonUK

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