Evaluvation of Perioperative Haemodynamic Changes in Hypertensive Patients Treated By Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker, Undergoing Elective Abdominal Surgery Under General Anaesthesia
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of Efficacy of Various Doses of Esmolol In Attenuating Presssor Re...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Randomized controlled trial of 12-week yoga therapy as lifestyle intervention...Yogacharya AB Bhavanani
Randomized controlled trial of 12-week yoga therapy as lifestyle intervention in patients of essential hypertension and cardiac autonomic function tests
Randomized controlled trial of 12-week yoga therapy as lifestyle intervention...Yogacharya AB Bhavanani
Background: In the Indian subcontinent, 118 million people are with hypertension, and this figure is anticipated to double by 2025. Yoga has been widely claimed to play a role in the prevention and management of psychosomatic, stress-induced, and lifestyle disorders such as hypertension. Aims and Objective: To study the effect of 12 weeks of yoga therapy as a lifestyle intervention on cardiac autonomic functions in patients of essential hypertension. Materials and Methods: Subjects with hypertension from the Medicine Outpatient Department of the Jawaharlal Institute of Postgraduate Medical Education and Research were randomized into control and yoga groups. The control group was treated only with the allopathic medicines. The yoga group was given 12 weeks of yoga therapy module designed by JIPMER Institute Advanced Center for Yoga Therapy Education and Research along with the routine medical treatment. The participants’ blood pressure and cardiac autonomic function were recorded before and after the 12 weeks of the study period. Result: No significant change was observed in the body weight (BW), body mass index (BMI), abdominal circumference, and waist–hip ratio (WHR) in both the control and yoga groups at the end of the 12 week-study period. There was a significant decrease in the resting systolic pressure (SP), diastolic pressure (DP), rate pressure product (RPP), and mean arterial pressure (MAP) in the yoga group. In contrast, there was no significant change in the SP, DP, RPP, and MAP of the control group. High frequency (HF) power, total spectral power, and HF normalized units (nu) showed a significant increase in the yoga group. Low frequency (LF) power, HF power, and LF (nu) showed a significant (p o 0.05) decrease in the yoga group at the end of the 12-week yoga therapy. Conclusion: Twelve weeks of yoga therapy reduced both the SP and DP in the yoga group. Furthermore, yoga therapy increased the heart rate variability and vagal tone and decreased the sympathetic tone in the subjects with hypertension. At the same time, it increased both the parasympathetic and sympathetic reactivity
Jyotsana. R. Bharshankar1, Archana D. Mandape, Mrunal S. Phatak, Rajay N. Bharshankar
Indian Journal of Physiology and Pharmacology 2015; 59(4). 396-401
Comparison of Efficacy of Various Doses of Esmolol In Attenuating Presssor Re...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Randomized controlled trial of 12-week yoga therapy as lifestyle intervention...Yogacharya AB Bhavanani
Randomized controlled trial of 12-week yoga therapy as lifestyle intervention in patients of essential hypertension and cardiac autonomic function tests
Randomized controlled trial of 12-week yoga therapy as lifestyle intervention...Yogacharya AB Bhavanani
Background: In the Indian subcontinent, 118 million people are with hypertension, and this figure is anticipated to double by 2025. Yoga has been widely claimed to play a role in the prevention and management of psychosomatic, stress-induced, and lifestyle disorders such as hypertension. Aims and Objective: To study the effect of 12 weeks of yoga therapy as a lifestyle intervention on cardiac autonomic functions in patients of essential hypertension. Materials and Methods: Subjects with hypertension from the Medicine Outpatient Department of the Jawaharlal Institute of Postgraduate Medical Education and Research were randomized into control and yoga groups. The control group was treated only with the allopathic medicines. The yoga group was given 12 weeks of yoga therapy module designed by JIPMER Institute Advanced Center for Yoga Therapy Education and Research along with the routine medical treatment. The participants’ blood pressure and cardiac autonomic function were recorded before and after the 12 weeks of the study period. Result: No significant change was observed in the body weight (BW), body mass index (BMI), abdominal circumference, and waist–hip ratio (WHR) in both the control and yoga groups at the end of the 12 week-study period. There was a significant decrease in the resting systolic pressure (SP), diastolic pressure (DP), rate pressure product (RPP), and mean arterial pressure (MAP) in the yoga group. In contrast, there was no significant change in the SP, DP, RPP, and MAP of the control group. High frequency (HF) power, total spectral power, and HF normalized units (nu) showed a significant increase in the yoga group. Low frequency (LF) power, HF power, and LF (nu) showed a significant (p o 0.05) decrease in the yoga group at the end of the 12-week yoga therapy. Conclusion: Twelve weeks of yoga therapy reduced both the SP and DP in the yoga group. Furthermore, yoga therapy increased the heart rate variability and vagal tone and decreased the sympathetic tone in the subjects with hypertension. At the same time, it increased both the parasympathetic and sympathetic reactivity
Jyotsana. R. Bharshankar1, Archana D. Mandape, Mrunal S. Phatak, Rajay N. Bharshankar
Indian Journal of Physiology and Pharmacology 2015; 59(4). 396-401
3. Exercise Intolerance and its treatment with exercise-based cardiac rehabil...ShagufaAmber
Heart failure with preserved ejection fraction (HFpEF) is the fastest growing form of heart failure in the United States and is associated with high morbidity and mortality. It refers to the preserved left ventricular (LV) ejection fraction and this phenotype is more common in older individuals, women, and those with history of hypertension, obesity, and anemia. (Benjamin et al., 2019, Fukuta et al., 2019)Exercise intolerance ( decreased peak oxygen uptake and · Vo2peak) secondary to impaired cardiac, vascular, and skeletal muscle function is a hallmark feature in clinically stable HFpEF patients and is associated with reduced quality of life
4. Physiotherapeutic approach of management in mechanically ventilated patient.ShagufaAmber
Mechanical ventilation (MV) is one of the most common interventions in the intensive care unit (ICU). Physical therapy includes early mobilisation to improve functional outcomes. Physical therapy interventions include passive movements of the extremities for deeply sedated patients, in-bed and out-of-bed mobility, active or passive cycling ,neuromuscular electrical stimulation and ambulation.Chest physiotherapy facilitates removal of retained or profuse airway secretions aiming to reduce airway resistance, optimize lung compliance, and decrease the work of breathing. Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients.
2. Special consideration in cardiac rehabilitation program for older adults.ShagufaAmber
An increasing number of cardiac patients are above the age of 65 years . They are susceptible to the adverse effect of bed rest . So early mobilization is especially important to return them to active and independent lifestyle.
- Most of the patients with heart failure, are elderly patients, shooting up to 80% in both incidence and prevalence.This is due to improved and better survival after cardiac insults, such as myocardial infarction, especially in developed countries.(AHA,2013).
-The safety and efficacy of cardiac rehabilitation have been demonstrated in the elderly (age >65 years) .(Pasquali ,et al.,2001)
-CR has a class IA recommendation by the AHA and ACSM for secondary prevention after any coronary heart disease
Effect of yogic practices on the selected physiological variables among the m...Sports Journal
The present study is to analyze the effect of Yogic practices on the selected physiological variables
among the middle aged men. For this study 100 middle age male persons were selected from Yazh Yoga
Coimbatore city, after the scrutiny by the scholar and experts 30 middle aged men were selected as
subjects by adopting purposive random sampling technique. The age of the subjects ranged from 35 to 45
years. They were divided into two equal groups namely, the group were assigned Asana, Pranayama,
Meditation (APMTG) and Control group (CG). The subjects were tested to find out the Resting Pulse
Rate, Vital Capacity and Blood Pressure. The pulse rate was assessed by arterial pulse, vital capacity was
measured by digital Spiro meter and blood pressure was measured by sphygmomanometer. The Asana,
Pranayama, Meditation(APMTG) Yoga group participated in Yogic practices for a period of twelve
weeks and control group did not participate in any special practice. The data were collected before and
after the training period and the pretest, post-test and the adjusted post-test were analyzed by Analysis of
Covariance (ANCOVA). The level of significance for the study was chosen as 0.05. It is concluded from
the results that the APMTG group has significant improvement in resting pulse rate, vital capacity and
blood pressure among middle aged men.
Prospective Randomized Double-Blind Study of Effectiveness of Dexmedetomidine...asclepiuspdfs
Introduction: Laryngoscopy and endotracheal intubation is associated with transient increase in heart rate (HR) and arterial blood pressure due to the sympathoadrenal stimulation. It can produce deleterious effects in patients with cardiovascular and cerebrovascular disease, in the form of myocardial ischemia, pulmonary edema, and cerebral hemorrhage. Dexmedetomidine has been effective in blunting the hemodynamic response to laryngoscopy and tracheal intubation. In this study, we used dexmedetomidine in pre-operative intravenous infusion dose of 1 mcg/kg over 20 min before induction. Aims and Objectives: The aim of the study was to study the efficacy and safety of dexmedetomidine on attenuation of pressor response during laryngoscopy and tracheal intubation, w.r.t. (1) pressor response during laryngoscopy and tracheal intubation, (2) hemodynamic stability, and (3) any adverse effects.
Effectiveness of Passive Range of Motion Exercises on Hemodynamic parameters ...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Effect of Inspiratory Muscle Training on Muscle Strength and Quality of Life ...kacm20
Effect of Inspiratory Muscle Training on Muscle Strength and
Quality of Life in Patients With Chronic Airflow Limitation:
a Randomized Controlled Trial
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of Ondansetron and Granisetron for Prevention of Nausea and Vomiti...Apollo Hospitals
The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The consequences of PONV are physical, surgical and anesthetic complications for patients as well as financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is 100% effective in prevention of PNV and combination therapy has got a lot of side effects.
3. Exercise Intolerance and its treatment with exercise-based cardiac rehabil...ShagufaAmber
Heart failure with preserved ejection fraction (HFpEF) is the fastest growing form of heart failure in the United States and is associated with high morbidity and mortality. It refers to the preserved left ventricular (LV) ejection fraction and this phenotype is more common in older individuals, women, and those with history of hypertension, obesity, and anemia. (Benjamin et al., 2019, Fukuta et al., 2019)Exercise intolerance ( decreased peak oxygen uptake and · Vo2peak) secondary to impaired cardiac, vascular, and skeletal muscle function is a hallmark feature in clinically stable HFpEF patients and is associated with reduced quality of life
4. Physiotherapeutic approach of management in mechanically ventilated patient.ShagufaAmber
Mechanical ventilation (MV) is one of the most common interventions in the intensive care unit (ICU). Physical therapy includes early mobilisation to improve functional outcomes. Physical therapy interventions include passive movements of the extremities for deeply sedated patients, in-bed and out-of-bed mobility, active or passive cycling ,neuromuscular electrical stimulation and ambulation.Chest physiotherapy facilitates removal of retained or profuse airway secretions aiming to reduce airway resistance, optimize lung compliance, and decrease the work of breathing. Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients.
2. Special consideration in cardiac rehabilitation program for older adults.ShagufaAmber
An increasing number of cardiac patients are above the age of 65 years . They are susceptible to the adverse effect of bed rest . So early mobilization is especially important to return them to active and independent lifestyle.
- Most of the patients with heart failure, are elderly patients, shooting up to 80% in both incidence and prevalence.This is due to improved and better survival after cardiac insults, such as myocardial infarction, especially in developed countries.(AHA,2013).
-The safety and efficacy of cardiac rehabilitation have been demonstrated in the elderly (age >65 years) .(Pasquali ,et al.,2001)
-CR has a class IA recommendation by the AHA and ACSM for secondary prevention after any coronary heart disease
Effect of yogic practices on the selected physiological variables among the m...Sports Journal
The present study is to analyze the effect of Yogic practices on the selected physiological variables
among the middle aged men. For this study 100 middle age male persons were selected from Yazh Yoga
Coimbatore city, after the scrutiny by the scholar and experts 30 middle aged men were selected as
subjects by adopting purposive random sampling technique. The age of the subjects ranged from 35 to 45
years. They were divided into two equal groups namely, the group were assigned Asana, Pranayama,
Meditation (APMTG) and Control group (CG). The subjects were tested to find out the Resting Pulse
Rate, Vital Capacity and Blood Pressure. The pulse rate was assessed by arterial pulse, vital capacity was
measured by digital Spiro meter and blood pressure was measured by sphygmomanometer. The Asana,
Pranayama, Meditation(APMTG) Yoga group participated in Yogic practices for a period of twelve
weeks and control group did not participate in any special practice. The data were collected before and
after the training period and the pretest, post-test and the adjusted post-test were analyzed by Analysis of
Covariance (ANCOVA). The level of significance for the study was chosen as 0.05. It is concluded from
the results that the APMTG group has significant improvement in resting pulse rate, vital capacity and
blood pressure among middle aged men.
Prospective Randomized Double-Blind Study of Effectiveness of Dexmedetomidine...asclepiuspdfs
Introduction: Laryngoscopy and endotracheal intubation is associated with transient increase in heart rate (HR) and arterial blood pressure due to the sympathoadrenal stimulation. It can produce deleterious effects in patients with cardiovascular and cerebrovascular disease, in the form of myocardial ischemia, pulmonary edema, and cerebral hemorrhage. Dexmedetomidine has been effective in blunting the hemodynamic response to laryngoscopy and tracheal intubation. In this study, we used dexmedetomidine in pre-operative intravenous infusion dose of 1 mcg/kg over 20 min before induction. Aims and Objectives: The aim of the study was to study the efficacy and safety of dexmedetomidine on attenuation of pressor response during laryngoscopy and tracheal intubation, w.r.t. (1) pressor response during laryngoscopy and tracheal intubation, (2) hemodynamic stability, and (3) any adverse effects.
Effectiveness of Passive Range of Motion Exercises on Hemodynamic parameters ...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Effect of Inspiratory Muscle Training on Muscle Strength and Quality of Life ...kacm20
Effect of Inspiratory Muscle Training on Muscle Strength and
Quality of Life in Patients With Chronic Airflow Limitation:
a Randomized Controlled Trial
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and In...
Similar to Evaluvation of Perioperative Haemodynamic Changes in Hypertensive Patients Treated By Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker, Undergoing Elective Abdominal Surgery Under General Anaesthesia
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of Ondansetron and Granisetron for Prevention of Nausea and Vomiti...Apollo Hospitals
The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The consequences of PONV are physical, surgical and anesthetic complications for patients as well as financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is 100% effective in prevention of PNV and combination therapy has got a lot of side effects.
Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – O...info622939
Embark on a compelling exploration of anesthesia innovation with our presentation on 'Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – Our Experience.' Delve into the intricacies of this specialized technique, tailored for high-risk cardiac patients, as we share our unique insights and experiences.
Hemodynamic Stress Response of Carbon-Di-Oxide Pneumoperitoneum during Laparo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
To Evaluate the Role of Inj. Ketamine (0.3mg/Kg) Intravenously, Before Skin I...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Effect of Intramuscular Injection Glycopyrrolate in Elderly Patients during S...QUESTJOURNAL
Background: Post spinal anaesthesia hypotension is a frequent complication and is deleterious in elderly patients due to associated co-morbid conditions and autonomic dysfunction. Prophylactic intramuscular Glycopyrrolate provides better hemodynamic stability in elderly patients. Aim: To evaluate the effect of intramuscular injection glycopyrrolate in elderly patients during spinal anaesthesia. Methods: It was a prospective, single blinded study undertaking 60 patients of ASA I and II including both sexes with age = / > 60 years. After ethical committee approval study groups were administered either I.M glycopyrrolate( Group G ) 0.2 mg or I.M Normal saline (Group N) 15 minutes prior to the induction of spinal anaesthesia. Heart rate ( HR ) and MAP ( Mean arterial pressure ), requirement of Ephedrine and side effects were noted intraopertively. Results: Both the groups were comparable with respect to demographic data and baseline hemodynamic parameters. Average HR and average MAP were significantly higher in Group G in comparison with Group N ( p value < 0.05 ). incidence of hypotension was more in group n 36.7 % in comparison with group g 16.7%. Conclusion: Glycopyrrolate is a safe drug, it doesn’t cross blood brain barrier. Its intramuscular use is a safe alternative method in preventing post spinal hypotension
Blood-Pressure Management in Patients with Acute Cerebral Hemorrhage
Kontroversi hasil studi ATACH-2 dan dampaknya dalam manajemen hipertensi pada stroke perdarahan intraserebral akut.
Subarachnoid Block With Low Dose Bupivacaine And Fentanyl In Elderly Hyperten...lgmitra01
read value of mg Fentanyl as mcg- printing error- posted as not available online anymore -
Subarachnoid Block With Low Dose Bupivacaine And
Fentanyl In Elderly Hypertensive Female Patients Undergoing Vaginal Hysterectomy
1Dr. Lalita Gouri Mitra, 2Dr.Suman Chattopadhyay, 3Dr. B. N.Biswas, 4Dr. Manjushree Ray, 5Dr.Pinaki
Mazumder.
INDPAIN FALL Vol. 20 No. 2, 2006
Acute Response of Manual Hyperinflation In Addition To Standard Chest Physiot...iosrjce
Background: Physiotherapists use manual hyperinflation (MHI) as a treatment for the recruitment of
collapsed lung and mobilization of excess pulmonary secretions .Purpose: To investigate the acute effect of
manual hyperinflation (MHI) on oxygenation and volume of secretions cleared in mechanically ventilated
patients.
Subjects and Methods: Manual hyperinflation was delivered in 30 medically stable, mechanically ventilated
patients . patients were randomly selected from Cairo university hospitals (critical care department). Their ages
ranged from 50 to 60 years .The study group A received both manual hyperinflation and standard chest
physiotherapy while control group B received standard chest physiotherapy only. Oxygenation parameters were
recorded before and after 30 minutes of treatment while secretion volume was recorded after 30 minutes of
treatment.
Results: The results of this study revealed statistically significant improvement in oxygenation parameters and
the amount of drained chest secretions in patients of both groups which was highly significant in favor of study
group A with P value ≤ 0.05.
Conclusion: Use of manual hyperinflation in combination with standard chest physiotherapy is a beneficial
method to clear lung secretions and improve oxygenation parameters in mechanically ventilated patients .
Postoperative Analgesia Effect Observation of Intercostal Nerve Block with Pe...semualkaira
Choose sixty patients received general anesthesia undergoing
video-assisted thoracoscopic lobectomy surgery. The patients were
randomly allocated into three groups (n=20each): ropivacaine
(group R), pentazocine (group P) and pentazocine combined with
ropivacaine (group P+R). At the time of subcutaneous suturing of
the thoracotomy wound, intercostal nerves were block by the same
thoracic surgery doctor in three groups. Follow up and record the
patients visual analogue scales(VAS) in quiet and cough at the
time of extubation and 1h ,2h ,6h ,8h ,12h ,24h after extubation.
Record the related postoperative adverse reactions incidence and
the usage of analgesics in the early postoperative period . OneWay ANOVA was conducted with P less than 0.05 as significant
level using SPSS software version 23.0.
Postoperative Analgesia Effect Observation of Intercostal Nerve Block with Pe...semualkaira
Choose sixty patients received general anesthesia undergoing
video-assisted thoracoscopic lobectomy surgery. The patients were
randomly allocated into three groups (n=20each): ropivacaine
(group R), pentazocine (group P) and pentazocine combined with
ropivacaine (group P+R). At the time of subcutaneous suturing of
the thoracotomy wound, intercostal nerves were block by the same
thoracic surgery doctor in three groups. Follow up and record the
patients visual analogue scales(VAS) in quiet and cough at the
time of extubation and 1h ,2h ,6h ,8h ,12h ,24h after extubation.
Record the related postoperative adverse reactions incidence and
the usage of analgesics in the early postoperative period . OneWay ANOVA was conducted with P less than 0.05 as significant
level using SPSS software version 23.0
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
Antioxidants Reduce Oxidative Stress in Claudicants
Similar to Evaluvation of Perioperative Haemodynamic Changes in Hypertensive Patients Treated By Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker, Undergoing Elective Abdominal Surgery Under General Anaesthesia (20)
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Emotional Intelligence and Work Performance Relationship: A Study on Sales Pe...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Customer’s Acceptance of Internet Banking in Dubaiiosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
A Study of Employee Satisfaction relating to Job Security & Working Hours amo...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
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Evaluvation of Perioperative Haemodynamic Changes in Hypertensive Patients Treated By Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker, Undergoing Elective Abdominal Surgery Under General Anaesthesia
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. VII (Nov. 2015), PP 19-23
www.iosrjournals.org
DOI: 10.9790/0853-141161923 www.iosrjournals.org 19 | Page
Evaluvation of Perioperative Haemodynamic Changes in Hypertensive
Patients Treated By Angiotensin Converting Enzyme Inhibitor or
Angiotensin II Receptor Blocker, Undergoing Elective Abdominal Surgery
Under General Anaesthesia
Kanth Sasi R1
, Gautam Rajiv2
, Giri Kr Manoj3
Malviya P.S4
1.
Junior Resident, 2.
Assistant Professor, 3.
Lecturer, 4.
Professor.
Dept. of Anaesthesiology, M.L.N. Medical College, Allahabad,India.
Abstract:
Aims: Our study is aimed to assess and evaluvate perioperative haemodynamic changes in hypertensive
patients treated by angiotensin converting enzyme inhibitor or angiotensin II receptor blocker, undergoing
elective abdominal surgery under general anaesthesia
Objectives: To study the haemodynamic changes on patients continuing/discontinuing Angiotensin Converting
Enzyme inhibitor or Angiotensin II Receptor Blocker on the day of surgery.
Methods: In this prospective study ,after randomization and double blinding 60 patients going for elective
abdominal surgery were selected in the surgery ward of swaroop rani hospital Allahabad . Amongst them, 30
patients (control group –GROUP A) did not consume any ACEI or AR blockers for controlling BP on the day
of surgery but the remaining 30 patients (experimental group- GROUP B) used the drugs on the day of
surgery . In these groups the effect of antihypertensives on hemodynamic changes before, during and after
surgery were studied by heart rate,blood pressure, ST-T segment changes ,SpO2 and statistical analysis using
Normal test for means and corresponding P values were calculated by Student t test and Fishers exact test.
Results: Pre-induction HR, SBP, DBP and MAP were comparable between groups( pre op “P” value > 0.05).
However when the post-induction values were compared with subsequent readings at 1min(“P” value <0.05),
3min(“P” value<0.0001), 5min (“P”value<0.0001), 10min(“P”value<0.0001), 15min(“P”value<0.0001),
20min(“P”value<0.0001) 30min(“P”value>0.05), 45min (“P”value>0.05)and 60min(“P”value>0.05) ,post
op(“P”value>0.05) it was found that there was a significant reduction in HR, SBP, DBP and MAP in Group B
up to 20 min and needed vasopressors and atropine to maintain it..There was no ST-T changes and SpO2
changes in both groups.
Conclusions: Intraoperative haemodynamics can be safely managed when angiotensin converting enzyme
inhibitor or angiotensin II receptor blockers are withhold on the day of surgery.
Keywords: Angiotensin II receptor blocker, Angiotensin-converting enzyme inhibitors, General anesthesia,
Hypotension
I. Introduction
The use of angiotensin converting enzyme inhibitors(ACE inhibitors)is one of the means available to
block renin angiotensin system . Besides being the first line treatment of hypertension those drugs also decrease
morbidity and mortality in patients with heart failure, acute myocardial infarction, especially in patients with
low ejection fraction and they are also useful on the secondary prevention of strokes. Patients recovering from
unstable angina or acute myocardial infarction without elevation of the ST segment and who have concomitant
hypertension, diabetes mellitus or heart failure, represent another group that seems to benefit from the
continuous use of ACE inhibitors1
Preoperative maintenance of drugs such as beta blockers and centrally acting alpha 2 agonists to protect
the myocardium during the surgeries, and drugs whose preoperative discontinuation can cause rebound
hypertension such as centrally acting alpha 2 agonist is recommended2
. In contrast the continuation of drugs
such as angiotensin converting enzyme inhibitors, ARB II on the day of surgery based on reports of significant
hypotension after induction of anaesthesia suggesting a deleterious interaction between ACE inhibitors, ARB II
and anaesthestics in general has been questioned3
However discontinuation of drugs used for a long time such as antihypertensives can implicate on a
higher risk of intraoperative hypertensive peaks with harmful consequences for the patients2
.
Therefore the indication of angiotensin converting enzymes inhibitors or angiotensin II receptor
blockers in patients with hypertension has been well defined. Maintenance or discontinuation of this type of
drug on the day of anaesthesia and surgical procedure is controversial.
Hence the present study was conducted to asses and compare the effects of continuation of Angiotensin
converting enzyme inhibitors and Angiotensin II receptor blockers therapy on the day of surgery with
2. Evaluvation Of Perioperative Haemodynamic Changes In Hypertensive Patients Treated…
DOI: 10.9790/0853-141161923 www.iosrjournals.org 20 | Page
discontinuation of Angiotensin converting enzyme inhibitors and Angiotensin II receptor blockers therapy on
the day of surgery, on perioperative stability of cardiovascular system in abdominal surgical patients after
induction of general anaesthesia, and also to determine the measures to manage the complications.
II. Material And Methods
The study was conducted from August 2014 to august 2015, after obtaining approval from the hospital
ethical committee and consent from the patients. The type of study was randomized, prospective and double
blinded.
A total of 60 patients who were aged between 30 to 60 years, belonging to ASA grade II , receiving
only ACEI or ARB for control of hypertension for at least 1 months were included in the study.
Patients were randomized by sealed envelope technique into two equal groups, Group A and Group B.
Group A consisted of 30 patients whose ACEI or ARA drug was stopped on the day of surgery. Group B
consisted of 30 patients whose ACEI or ARA drug was continued on the day of surgery. Patients with valvular
and ischemic heart diseases, cardiac failure, Respiratory disorders, carcinoid tumors, pheochromocytoma or
thyrotoxicosis ,were excluded.
Anesthetic management was standardized by a study protocol. The pre medication drugs, induction
agents, analgesics, muscle relaxants and volatile anesthetic agents used for maintenance of anesthesia were the
same for all patients. In the pre operative room intravenous (IV) cannula was put under local anesthesia.Inj.
Midazolam 0.02 mg/kg and Inj.fentanyl 2.0 μg/kg ,Inj.glycopyrrolate0.2mg were given IV slowly. A crystalloid
infusion 10 ml/kg was given to all patients before induction followed by 5 ml/kg/h until the end of surgery.
All patients were induced with Inj. propofol 2.0-2.5 mg/kg, Inj. succinylcholine 1.5-2 mg/kg body
weight i.v. and tracheal intubation was performed with cuffed endotracheal tube. Anaesthesia was maintained
with 60%:40% (N2O:O2) with intermittent isoflurane (0.5-1%) on soda lime closed breathing circuit . Muscle
relaxation was maintained with loading dose of inj. vecuronium (0.04-0.07mg/kg) i.v. followed by
supplementary doses (0.01- 0.02mg/kg) i.v. as and when required.
After completion of anaesthesia, residual paralysis was reversed with neostigmine ( 0.05 mg/kg) i.v.
and glycopyrrolate (0.01mg/kg) i.v. Extubation is done after thorough suctioning of oral cavity.
Following parameters was observed for hemodynamic response and monitored perioperatively, just
before induction and after induction at 1, 3, 5, 10, 15,20, 30, 45 and 60 minute and post operative ward after 15
minutes of extubation.
A:- Heart Rate
B:- Blood Pressure
a. Systolic Blood Pressure
b. Diastolic Blood Pressure
c. Mean Arterial Blood Pressure
C: ST-T Segment Changes
D:- Pulse Oximetry Spo2
1. Hypotension was defined as SBP < 20% of baseline value.4
2. Bradycardia was defined as HR < 60 beats/ minute.5
3. Tachycardia was defined as HR > 25% of baseline value6
.
4. Hypertension was defined as SBP >20% of baseline value7.
Hypotension was treated initially with increasing the infusion rate of IV crystalloids (Ringer lactate),
giving a maximum of up to 500 ml within 5- 7 minutes followed by , IV ephedrine in incremental bolus doses of
10 mg. Whenever MAP was <60 mmHg, it was treated immediately with inj.vasopressin8
0.5-1U Bolus followed
by infusion0.03- 0.06U/minute i.v.
Bradycardia was treated with inj .atropine 0.6 mg i.v.
Hypertension and tachycardia was treated with inj. Esmolol 250-500 microgram/kg i.v. bolus over 1-2
minutes then 50 -300 microgram /kg/minute infusion
Statistical analysis was performed using Microsoft Excel 2010 and online statistical calculation
website. Student t-test (paired & unpaired), Fisher,
s exact test and Two Propotional Z test was used to test the
significance of data. Data were presented as mean ± S.D. A ‘P’ value of <0.05 was considered significant.
III. Results
Both groups were comparable with respect to, demographic profile i.e. age, weight, height & pre-
induction baseline vital parameters i.e. H.R. ,S.B.P., D.B.P.,M.A.P and SPO2 were statistically similar between
both groups.
3. Evaluvation Of Perioperative Haemodynamic Changes In Hypertensive Patients Treated…
DOI: 10.9790/0853-141161923 www.iosrjournals.org 21 | Page
In the present study, At T1 minute post induction mean HR(P>0.05) of group B was not significantly
lower than group A but, mean SBP (P<0.05), DBP (P<0.05) and MAP (P<0.05) were significantly lower than
group A . In group B mean HR, SBP., DBP and MAP at T3(P<0.0001), T5(P<0.0001),T10(P<0.0001),
T15(P<0.0001), T20,(P<0.0001) minute post induction were significantly lower than group A .At T30,T45,T60
minutes mean H.R., S.B.P., D.B.P., and M.A.P were statistically similar between both groups(P>0.05) . There
was statistically no significant difference (P>0.05) in SpO2 level between the groups from T1 to T60 minute .
There were no ST-T changes in both the groups from T1 to T60 minutes.
In our study patients who took ACE inhibitor or ARB(group B) associated with 100% hypotensive
(<20% of baseline blood pressure)episodes(P<0.0001) than group A in post induction period upto 20 minutes,
50%(15 patients) within 1 minute and 100%(30 patients) at 3 min. In group B, 20 patients required Ringer
lactate and i.v. ephedrine to maintain systolic blood pressure within 20% of baseline and in ten patients
(33.33%)we used vasopressin to maintain mean arterial pressure more than 60mmHg (out of five patients who
took enalapril on the day of surgery four patients needed vasopressin to maintain mean arterial blood pressure
more than 60mmHg and all the patients who took ARB on the day of surgery needed vasopressin to maintain
mean arterial pressure >60 mmHg) . In 15 patients(50%) out of 30 patients (GROUP B)we used atropine to
maintain heart rate more than 60/min. It was also statistically significant (P<0.0001)compare to group A where
there was no bradycardia episodes.
In group A hypotensive episodes occurred at 1minute in 9 patients (30%) and it was managed with
Ringer lactate within 3 min. In group A, 1 patient (3.3%) had hypertensive(> 20% of baseline) and
1patient(3.3%) had tachycardia( > 25% of baseline) episodes required esmolol to control it and it was
statistically insignificant(P>0.05) compare to group B . Mean HR, SBP, DBP, MAP, SPO2 were comparable
between the groups (P>0.05) at post - operative period .There were no ST-T segment changes in both groups
Figure:1 Comparision Of Heart Rate Between Two Groups
Figure:2 Comparision Of Systolic Blood Pressure Between Two Groups
0
20
40
60
80
100
120
PRE
INDU
T1 T3 T5 T10 T15 T20 T30 T45 T60 POST
OP
GRO…
0
20
40
60
80
100
120
140
PRE
INDU
T1 T3 T5 T10 T15 T20 T30 T45 T60 POST
OP
GRO…
4. Evaluvation Of Perioperative Haemodynamic Changes In Hypertensive Patients Treated…
DOI: 10.9790/0853-141161923 www.iosrjournals.org 22 | Page
Figure:3 Comparision Of Diastolic Blood Pressure Between Two Groups
Figure:4 Comparision Of Mean Arterial Pressure Between Two Groups
Analysis of complications after induction of anaesthesia
GROUP HYPOTENSION HYPERTENSION BRADYCARDIA TACHYCARDIA ST-T CHANGES
SPO2
CHANGES
A 9(30%) 1(3.33%) 0(0%) 1(3.33%) 0(0%) 0(0%)
B 30(100%) 0(0%) 15(50%) 0(0%) 0(0%) 0(0%)
P <0.0001 >0.05 <0.0001 >0.05 - -
IV. Discussion
The present study results comparable with several studies in the past, which had also reported
intraoperative hypotension with the use of ACEI and ARA in the surgical setting.[8,9,10,11,12,13, 14, 15,].
In the study done by Coriat, et al.,[8]
showed, In hypertensive patients chronically treated with
ACEIs, maintenance of therapy until the day of surgery may increase the probability of hypotension at
induction.. Our study results also suggest all the patients who took ACE inhibitors on the day of surgery to
control blood pressure were associated with 100% hypotensive episodes, needed ephedrine to maintain systolic
pressure within 20% of baseline and in four patients who took enalapril on the day of surgery required
vasopressin to maintain mean arterial pressure more than 60mmHg
This study result consistent with a study conducted by Brabant SM.,et al [9]
which has shown
hypotensive episodes occur more frequently after anesthetic induction in patients receiving Angiotensin II
receptor subtype-1 antagonists under anesthesia than with other hypotensive drugs. They are less responsive to
the vasopressors ephedrine or phenylephrine. The use of a vasopressin system agonist was effective in restoring
blood pressure when hypotension was refractory to conventional therapy
0
10
20
30
40
50
60
70
80
90
100
PRE
INDU
T1 T3 T5 T10 T15 T20 T30 T45 T60 POST
OP
GROU…
0
20
40
60
80
100
120
PRE
INDU
T1 T3 T5 T10 T15 T20 T30 T45 T60 POST
OP
GRO…
5. Evaluvation Of Perioperative Haemodynamic Changes In Hypertensive Patients Treated…
DOI: 10.9790/0853-141161923 www.iosrjournals.org 23 | Page
In the study by Comfere et al.,[11]
it was reported that hypotension occurred in about 60% of patients
who had last ACEI or ARA therapy less than 10 h prior to anesthetic induction. But in our study, all the
patients who had ACEI or ARA on the day of surgery developed hypotension. The difference may be due to
various induction agents like thiopentone and propofol were used by Comfere et al.,[11]
. In our study,we used
only propofol as an induction agent, and also patients took ACEI and ARB on the day of surgery morning
which could have caused more frequent hypotensive episodes . Malgorzata et al.[16]
also found more profound
hypotension with propofol induction when compared with etomidate induction in the patients who had received
ACEI.
This study result also consistent with a study conducted by Schirmer U, et al.[14],
that continuation of
ACEI on the day of surgery associated with significant reduction in post induction heart rate, SBP , DBP,MAP
and more hypotensive and bradycardia episodes compared to the discontinuation group.
This study result also consistent with a study conducted by Rajan et al.[15],
that continuation of ACEI
or ARB on the day of surgery associated with significant reduction in post induction blood pressure.In our study
post induction hypotension upto 20 minutes only because of vasopressors support.
V. Conclusion
Continuation of ACEI or ARB on the morning of day of surgery produces undesirable hypotension and
bradycardia after induction of general anaesthesia.
The number of complications were more in patients with continuation of antihypertensive drugs,
however they were manageable.
These drugs should be withheld on the day of surgery and sequele arising can be easily managed.
It is concluded that patients taking ACEI or ARB should withheld these drugs on the day of surgery.
References
[1]. Yusuf S, Sleight P, Pogue J et al. Effect of angiotensin converting enzyme inhibitor, ramipriloncardiovascular events in high risk
patients. New England J Med, Jan 20,2000;342(3):145-53
[2]. Schmidt GR, Schuna A A. Rebound hypertension after discontinuation of transdermal clonidine. clin pharm ,1988;7:772-774
[3]. Ryckwaert F; Colson P. Haemodynamic effects of anaesthesia in patients with ischemic heart failure chronically treated with
angiotensin converting enzyme inhibitors. Anesth&analg, May 1997;84(5):pp945-949.
[4]. Jakola ML, Ali-Melkkila T, Kanto J, Kallio A, Scheinin H, ScheininM.Dexmedetomidine reduces intraocular pressure, intubation
response andanaesthetic requirements in patients undergoing ophthalmic surgery. BrJAnaesth 1992;68:570-5.
[5]. Kallio A, Scheinin M, Koulu M, Ponkilainen R, Ruskoaho H, Viinamaki O, et al. Effects of dexmedetomidine, a selective alpha-2
adrenoceptor agonist, on haemodynamic control mechanism. ClinPharmacolTher 1989;46:33-42.
[6]. Nathaniel H. Greene, B.S., Craig Weldon, M.D., Terri G. Monk, M.D., M.S. There Are No Consistent Definitions of Hemodynamic
Aberrations in the Anesthesia Literature Anesthesiology, Duke University School of Medicine, Durham, North Carolina, 2008.
[7]. Wheeler AD, Turchiano J, Tobias JD A case of refractory intraoperative hypotension treated with vasopressin infusion. J
ClinAnesth. 2008 Mar; 20(2):139-42.
[8]. Coriat P, Richer C, Douraki T, Gomez C, Hendricks K, Giudicelli JF, et al. Influence of chronic angiotensin-converting enzyme
inhibition on anesthetic induction. Anesthesiology. 1994;81:299–307.
[9]. Brabant SM, Bertrand M, Eyraud D, Darmon PL, Coriat P. The hemodynamic effects of anesthetic induction in vascular surgical
patients chronically treated with angiotensin II receptor antagonists. AnesthAnalg. 1999;89:1388–92.
[10]. Bertrand M, Godet G, Meersschaert K, Brun L, Salcedo E, Coriat P. Should the angiotensin II antagonists be discontinued before
surgery? AnesthAnalg. 2001;92:26–30.
[11]. Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA, et al. Angiotensin system inhibitors in a general surgical
population. AnesthAnalg. 2005;100:636–44.
[12]. Park KW. New therapeutic targets and modalities in cardiovascular medicine. IntAnesthesiol Clin.2005;43:23–37.
[13]. Khodaparast O, Kheterpal S, Shanks A, Tremper KK. Chronic treatment with ACE inhibitors or ARAs and intra-operative
hypotension. Anesthesiology. 2006;105:A44.
[14]. Schirmer U, Schürmann W. Preoperative administration of angiotensin-converting enzyme inhibitors.Anaesthesist. 2007;56:557–
61.
[15]. Rajan S, Rajagopalan R, SapruK ,Paul J: Effect of preoperative discontinuation of angiotensin converting enzyme inhibitors or
angiotensin II receptor antagonists on intraoperative arterial pressure after induction of general anaesthesia. Anesthesia Essays and
Researches.Jan-Apr 2014; 8(1): 32-35.
[16]. Malinowska-Zaprzałka M, Wojewódzka M, Dryl D, Grabowska SZ, Chabielska E. Hemodynamic effect of propofol in enalapril-
treated hypertensive patients during induction of general anesthesia. Pharmacol Rep.2005;57:675–8.