· If a patient is maintained on ACEI/ARB treatment before surgery, it is reasonable to withhold it temporarily to prevent hypotension during induction of anaesthesia[1,2]. As most ACEI/ARBs have short half-lives, cessation 24 hours prior to surgery appears the most pragmatic approach. Although a ‘withdrawal’ state from abrupt cessation of those drugs is theoretically plausible, there is no reliable evidence supporting that.
· In patients on ACEI/ARB treatment for heart failure, it is reasonable to continue it during the perioperative period under close monitoring. If patients are not on those agents pre-operatively, it is recommended to start them after the first post-operative week.
· If a patient is on ACEI/ARB treatment pre-operatively, it should be resumed as soon as possible following the surgical procedure [1,2]. Once the patient is haemodynamically stable, the risks associated with post-operative RAAS inhibition are outweighed by the benefits provided that renal function is not compromised.
· If a patient is not on ACEI/ARB therapy, evidence hitherto available does not support starting it pre-operatively (other than possibly in patients undergoing CABG ). Further research is warranted to better clarify whether this approach brings any benefit for perioperative or long-term outcomes.Read More