Case Report: Refractory hypotension during general anesthesia despite preoperative discontinuation of an angiotensin receptor blocker [version 1; referees: 2 approved]

Due to their beneficial reduction in morbidity and mortality angiotensin receptor blockers (ARBs) have become increasingly popular to treat hypertension. However, similar to angiotensin converting enzyme inhibitors, they can lead to severe hypotension in conjunction with general anesthesia and thus have been recommended to be withheld in the morning of surgery. Here, we present a 51 year old female who developed severe refractory hypotension after induction of general anesthesia, although she had discontinued her medication 24 hours preoperatively as instructed. Therefore, halting ARBs for more than 24 hours before surgery may be necessary. Heightened awareness of this potential interaction and recognizing the need to treat with vasopressin is required when ARB-induced hypotension occurs. Matthias L Riess ( ) Corresponding author: [email protected] Nabbi R, Woehlck HJ and Riess ML. How to cite this article: Case Report: Refractory hypotension during general anesthesia despite 2013, :12 (doi: preoperative discontinuation of an angiotensin receptor blocker [version 1; referees: 2 approved] F1000Research 2 ) 10.12688/f1000research.2-12.v1 © 2013 Nabbi R . This is an open access article distributed under the terms of the , which Copyright: et al Creative Commons Attribution Licence permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the (CC0 1.0 Public domain dedication). Creative Commons Zero "No rights reserved" data waiver Institutional support only (RN, HJW and MLR). No grants were involved in supporting this particular work. Unrelated research Grant information: support for MLR through the Department of Veterans Affairs (CARA-026-10F) and NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No competing interests were disclosed. Competing interests: 14 Jan 2013, :12 (doi: ) First published: 2 10.12688/f1000research.2-12.v1 1 1