Does Perioperative Angiotensin-Converting Enzyme Inhibitor Therapy Correlate with Increased use of Vasopressors during Posterior Lumbar Interbody Fusion versus those not Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: A Retrospective Study
Date of Award
Management Practice in Nurse Anesthesia
Type of Degree
Alberto Coustasse, Committee Chair, Graduate College of Business, Marshall University
Priscilla Walkup, Committee Member, CAMC School of Nurse Anesthesia
Megan Orphanos, Committee Member, CAMC Health System, Memorial Hospital
Abstract: The purpose of this study was to evaluate if patients who took Angiotensin Converting Enzyme (ACE) inhibitors the morning of surgery for Posterior Lumbar Interbody Fusion (PLIF) required more treatment for intraoperative hypotension.
Introduction: PLIF is a surgical procedure used to correct spinal disorders that include compression, instability, pathological lesions, deformities, and pain. PLIF is completed utilizing the prone position for optimal access to the lumbar spine. Complications associated with prone position have included Post-Operative Vision Loss (POVL), compression of abdominal vessels, and head and neck venous compression resulting in neurologic injury. Currently, there are no set recommendations on ACE Inhibitor continuation before surgery, unlike those on a beta antagonist. There is a lack of research on the effect of the continuation of ACE inhibitors on intraoperative hypotension and vasopressor administration.
Methodology: This study used a retrospective, case-control study design. A chart review was conducted from January 1, 2007, through January 1, 2017 on patients undergoing PLIF. A total of 200 patients were included in this study sepearted into two groups, those who held their ACE inhibitors and those who continued their ACE inhibitors. Patient information collected included: amount of phenylephrine received, amount of ephedrine received, lowest systolic blood pressure, and lowest diastolic blood pressure. The age and BMI was compared using t-tests and chi-square tests for gender and ASA physical status. A total of two linear regressions were completed to examine the lowest systolic blood pressure, lowest diastolic blood pressure, total phenylephrine dose, and total ephedrine dose.
Results: The mean age of the total study sample was 57.25 ± (12.57). There were 47.5% male patients and 52.5% female patients. The mean BMI was 31.01± (6.71). The ASA physical status ranged from 2 to 4 with 27% ASA 2, 69% ASA 3, and 4% ASA 4. There was no statistically significant difference found in age, gender, BMI, or ASA physical status between groups. The mean systolic blood pressure was 84.38 ± (7.45), mean diastolic blood pressure was 44.61 ± (7.38), mean ephedrine doses were 4.72 ± (4.10), and mean phenylephrine doses were 3.57 ± (4.40). Data did not support a statistically significant difference in lowest systolic blood pressure, lowest diastolic blood pressure, total phenylephrine dose, or total ephedrine dose between groups.
Discussion: This study did not find an association between patients taking ACE inhibitors and increased requirements of vasopressors, lower systolic blood pressure, or lower diastolic blood pressure. The results of this current study are inconsistent with existing literature and could be explained by the retrospective nature of the study, small sample size, and only one hospital network used for patients. There were several limitations identified and discussed in this study.
Conclusion: In this study, the use of ACE inhibitors the morning of surgery was not associated with more doses of vasopressor medications, lower systolic blood pressure, or lower diastolic blood pressure in patients undergoing PLIF.
Implications/Recommendations: This study provided clinical relevance to anesthesia practitioners, researchers, and physicians about the use of ACE inhibitors for patients undergoing PLIF. Knowledge of ACE inhibitors and their effects help anesthesia providers customize the anesthetic to optimize patient safety.
Anesthesiology -- Research.
Nursing -- Research.
Ross, Joshua, "Does Perioperative Angiotensin-Converting Enzyme Inhibitor Therapy Correlate with Increased use of Vasopressors during Posterior Lumbar Interbody Fusion versus those not Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: A Retrospective Study" (2017). Theses, Dissertations and Capstones. 1058.