Effects of discontinuing angiotensin receptor blockers on perioperative hypotension in patients undergoing laparoscopic cholecystectomy

Abstract

Corresponding author Seongheon Lee Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Gwangju 61469, Korea Tel: +82-62-220-6895 Fax: +82-62-232-6294 E-mail: aneshead@gmail.com ORCID: http://orcid.org/0000-0002-2675-2521 Continuing angiotensin receptor blockers (ARBs) until the day of surgery remains controversial because of the risk of intraoperative hypotension. This study was aimed at evaluating the perioperative hemodynamic changes and postoperative complications associated with continuation or discontinuation of ARBs in patients undergoing laparoscopic cholecystectomy. A total of 283 patients with antihypertensive medication, including ARBs, were enrolled in this retrospective study. On the day of surgery, ARBs were continued in some patients (continuation group, n=111) and discontinued in other patients (discontinuation group, n=172). On the basis of the patients’ electronic medical records, hemodynamic values (systolic blood pressure, mean arterial pressure, and heart rate) were compared before anesthesia (baseline), at 10 min after induction (post-induction), and on arrival at the post-anesthesia care unit (postanesthesia). Vasoactive drug use, postoperative complications, and length of hospital stay were compared. The blood pressures and heart rates at baseline and post-induction were not significantly different between the groups. The number of patients who required ephedrine to correct intraoperative hypotension was significantly higher in the continuation group than in the discontinuation group (27.9% vs. 14.5%, p=0.009). The systolic blood pressure at postanesthesia was significantly higher in the discontinuation group (159.9±21.7 vs. 146.4±20.9, p<0.001). The postoperative complications and length of hospital stay were similar. Discontinuing ARBs may reduce the incidence of intraoperative hypotension requiring pharmacological intervention in patients undergoing laparoscopic cholecystectomy; however, possible occurrence of postoperative hypertension should be considered.