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  • Writer's pictureBeat To Beat Training LLC

Hold or HODL?

We all know that anesthesia induction "usually" causes a drop in SBP. Though there is NO universal agreement, anesthesia providers typically believe

👉ACE INHIBITORS (catopril, enalapril, lisinopril, ramipril)


👉ANGIOTENSIN RECEPTOR ANTAGONISTS ( losartan, irbestartan, candesartan)

Should be held the day of surgery...


These drugs inhibit RAS (renin angiotensin system)

But what if your patient didnt get the MEMO...

And TOOK their usual medications ON THE DAY of surgery???

Is CANCELECTOMY an option?? 😂

Ace inhibitors and angiotensin receptor antagonists block the bodys POTENT vasoconstrictor...

That means patients typically LOOSE sympathetic tone...

Well what about the kidneys???

Cant the kidneys respond by retaining fluids through ADH (aka vasopressin)?

It could!

BUT if this is the only system that is intact to maintain BP keep in mind that it tends to correct BP SLOWLY... 🐌🐌🐌 when compared to other possible interventions that you as a provider can do...

So now what?

Should we activate our

internal screams???

Ofcourse not!


Even though immediate drugs such as our famous

Phenylephrine and ephedrine

Are available, these drugs are usually INSUFFICIENT because remember, RAS is blocked!

So after adding fluids to your first line of defense,

Help your patient by adding VASOPRESSIN to your drug of choice in treating hypotension during peri induction period.

Think of it this way,

As an anesthesia provider, you are giving your patient a "boost" based on how it would typically respond.

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Disclaimer: The American Heart Association strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association, and any fees charged for such a course do not represent income to the Association. 

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