ACE Inhibitors & ARBS
- ACE inhibitors and angiotensin receptor antagonists should be held the day of surgery.
- Peri-induction hypotension can result from the loss of sympathetic tone associated with anesthesia induction superimposed upon renin-angiotensin system (RAS) blockade. The vasopressin system is the only intact system left to maintain BP, and vasopressin release is not a fast response system compared to the sympathetic nervous system. The usual pressors used intraoperatively (ephedrine and phenylephrine) might be insufficient with RAS blockade as well as sympathetic tone loss associated with anesthesia induction.
