背景:血管紧张素II受体阻滞剂(ARB)目前被认为是一线降压药,有效抑制肾素-血管紧张素-醛固酮系统。然而,ARBs与全身麻醉期间的术中低血压有关。虽然建议在手术前24小时停止ARBs,最佳停药时间尚不清楚.我们提出了在全身麻醉期间遇到的严重难治性低血压,尽管在麻醉前停止ARBs48小时。
方法:一名66岁男性患者(170cm/75kg)在颅骨修补术的全身麻醉诱导过程中发生了严重的难治性低血压。病人正在服用阿齐沙坦,血管紧张素受体阻滞剂,对于高血压,在麻醉诱导前48小时停药。尽管反复服用麻黄碱和连续输注去甲肾上腺素,血流动力学不稳定没有改善.因此,手术被推迟了.
方法:患者被诊断为血管紧张素受体阻滞剂引起的难治性低血压。
方法:在第二次手术之前,手术前96小时停用血管紧张素受体阻滞剂.麻醉诱导前进行有创血压监测,并准备了加压素.全身麻醉是使用雷米唑仑诱导的,并用地氟醚维持。
结果:手术顺利完成,未发生难治性低血压。
结论:血管紧张素受体阻滞剂诱导的难治性低血压即使在全身麻醉诱导前停药48小时后仍可发生。尽管扣留了药物,对于服用ARBs的患者在全身麻醉期间的低血压,应谨慎行事。
BACKGROUND: Angiotensin II receptor blockers (ARBs) are currently considered first-line antihypertensive drugs, effectively inhibiting the renin-angiotensin-aldosterone system. However, ARBs have been associated with intraoperative hypotension during general anesthesia. Although it is recommended to discontinue ARBs for 24 hours before surgery, the optimal duration of discontinuation remains unclear. We present a severe refractory hypotension encountered during general anesthesia despite discontinuing ARBs for 48 hours before anesthesia.
METHODS: A severe refractory hypotension occurred during the induction of general anesthesia for cranioplasty in a 66-year-old male patient (170 cm/75 kg). The patient was taking azilsartan, angiotensin receptor blocker, for hypertension, which was discontinued 48 hours before anesthesia induction. Despite repeated administration of ephedrine and continuous infusion of norepinephrine, hemodynamic instability did not improve. Therefore, the surgery was postponed.
METHODS: The patient was diagnosed with angiotensin receptor blocker-induced refractory hypotension.
METHODS: Before the second surgery, the angiotensin receptor blocker was discontinued 96 hours prior to the surgery. Invasive blood pressure monitoring was performed before anesthesia induction, and vasopressin was prepared. General anesthesia was induced using remimazolam and maintained with desflurane.
RESULTS: The surgery was completed successfully without occurrence of refractory hypotension.
CONCLUSIONS: Refractory hypotension induced by Angiotensin receptor blockers can still occur even after discontinuing the medication for 48 hours before induction of general anesthesia. Despite withholding the medication, caution should be practiced regarding hypotension during general anesthesia in patient taking ARBs.