Dados do Trabalho

Título

Effects of withdrawing vs continuing renin-angiotensin blockers or angiotensin-converting enzyme inhibitors on perioperative period: a systematic review and meta-analysis

Descrição

Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Blockers (ARBs) are crucial medications for managing hypertension, heart failure, and post-myocardial infarction. Their impact on intraoperative hemodynamics requires careful evaluation to determine whether these medications should be continued or withheld before surgery. This meta-analysis aims to determine the effects of withholding or continuing ACEIs and ARBs in the perioperative period, focusing on hemodynamic parameters such as the incidence of hypotension, mean systolic blood pressure (SBP) after anesthesia induction, and average mean arterial pressure. This meta-analysis followed the PRISMA protocol registered with PROSPERO (protocol CRD42024567331, registered on July 10, 2024). The database search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials databases until May 8, 2024. Eligibility criteria included randomized clinical trials comparing the continuation or suspension of ACEI/ARB use before surgery. Primary outcomes evaluated were the incidence of systolic blood pressure below 90 mmHg, mean systolic blood pressure after anesthesia induction, and average mean arterial pressure post-anesthesia induction. Secondary outcomes were mean infused fluid volume during anesthesia induction and incidence of norepinephrine use during anesthesia and/or surgery. Twelve randomized clinical trials with 1550 patients were included after study selection. The continuation group had a higher incidence of systolic blood pressure below 90 mmHg (30.0% vs. 18.1%; P = 0.02; I2 = 53%). No statistically significant differences were found in norepinephrine use (6.9% vs. 9.3%; P = 0.90; I2 = 0%), mean SBP after induction (P = 0.14; I2 = 43%), average mean arterial pressure post-induction (P = 0.41; I2 = 73%), and mean infused fluids during induction (P = 0.28; I2 = 85%). Continuing ACEI/ARB therapy in the perioperative period is associated with a higher incidence of intraoperative hypotension. These findings underscore the importance of evaluating hemodynamic stability when deciding on the continuation or suspension of ACEI/ARB therapy in the perioperative setting. Given the variability in outcomes and the presence of significant heterogeneity in some measures, further high-quality research is necessary to refine guidelines for the perioperative management of these medications, ensuring optimal patient outcomes.

Referência 1

AHMADI, S. et al. Hemodynamic Changes After Continuing or Omitting Regular Angiotensin Converting Enzyme Inhibitors Before Cataract Surgery: A Comparative Study. Current Hypertension Reviews, v. 19, 12 jan. 2023.

Referência 2

ACKLAND, G. L. et al. Discontinuation vs. continuation of renin–angiotensin system inhibition before non-cardiac surgery: the SPACE trial. European Heart Journal, 3 nov. 2023.

Palavras Chave

Perioperative Care; Hemodynamics; ACE inhibitors