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임상연구 : 체외순환 없는 관상동맥우회술을 시행 받는 환자에서 수술 전 안지오텐신 전환효소 억제제 중단이 혈역학에 미치는 영향
이용경 ( Yong Kyung Lee ),나성원 ( Sung Won Na ),남순호 ( Soon Ho Nam ),남성범 ( Sang Boem Nam ),채영근 ( Young Keun Chae ),송하나 ( Ha Na Song ),곽영란 ( Young Lan Kwak ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: Angiotensin-converting enzyme inhibitors (ACE-I) have been widely used for cardiac patients. This study investigated the effect of omitting ACE-I medication on hemodynamics during induction of anaesthesia and operation in patients chronically treated with ACE-I undergoing off pump coronary artery bypass graft surgery (OPCAB). Methods: Sixty patients scheduled for OPCAB were included in this study. Patients not treated with ACE-I were included in control group (Group I, n = 20). And then, patients treated with ACE-I more than 4 weeks were randomly divided into two groups: continuing group including patients who continued ACE-I medication until the morning of surgery (Group 2, n = 20) and discontinuing group including patients who discontinued ACE-lone day before the surgery (Group 3, n = 20). Norepinephrine (8㎍/ml) was infused when systolic blood pressure decreased below 90 mmHg during induction and operation. Amount of norepinephrine infused and hemodynamic data were recorded. Results: Significantly larger amount of norepinephrine was infused in Group 2 than in other two groups during obtuse marginal artery anastomosis. Total amount of norepinephrine infused during the all coronary anatsomosis was significantly larger in Group 2 than those values in other two groups. Conclusions: Continuing ACE-I treatment until the morning of surgery significantly increased the use of norepinephrine during the anastomosis. In contrast, there was no significant difference in the use of norepinephrine between Group I and Group 3. Discontinuing ACE-I before the surgery may helpful to maintain hemodynamics stable during coronary anastomosis in OPCAB. (Korean J Anesthesiol 2007; 52: 34~41)
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