Arginine vasopressin in patients receiving chronic ACE inhibitor treatment with prolonged postoperative hypotension

作者：Luckner G^*; Jochberger S; Mayr V D; Wenzel V; Ulmer H; Hasibeder W R; Duenser M W

来源：Anasthesiologie & Intensivmedizin, 2008, 49: 624-+.

• Arginine Vasopressin
• ACE Inhibitors
• Postoperative Hypotension
• Vasopressor Requirement
• Phenylephrine

Background: Since angiotensin 11 is a physiological stimulator of arginine vasopressin (AVID), perioperative hypotension in patients on chronic angiotensin converting enzyme (ACE) inhibitor therapy may be due to AVP deficiency. In the present study, we investigated the hypothesis that a low-dose AVP infusion might reverse prolonged postoperative hypotension in patients chronically treated with an ACE inhibitor.
Methods: Fifteen patients with chronic ACE inhibitor intake and isolated postoperative vasodilatory hypotension requiring prolonged phenylephrine (> 24 hrs) and receiving a supplementary, low-dose infusion of AVP (2 IU/h) were entered into this retrospective analysis. Demographic and clinical data were documented for all patients. Haemodynamic and laboratory parameters were recorded 24, 12, 6 hrs, and immediately prior to initiation of AVID treatment; as well as 6, 12, 24, and 48 hrs after initiation and discontinuation of the AVP infusion.
Results: During the study period, no significant effects of AVP on phenylephrine requirement (p=0.21) or mean arterial blood pressure (p=0.11) were observed. Phenylephrine infusion could be discontinued in seven patients 57 56 hrs after initiating AVP treatment. The AVID infusion could subsequently be terminated in only a single patient. No changes in laboratory parameters occurred during the study period.
Conclusions: Low-dose AVP infusion appears to be ineffective for reversing prolonged postoperative hypotension in patients on chronic ACE inhibitor therapy. Prospective studies including larger numbers of patients are necessary to confirm these preliminary results.

• 出版日期2008-12