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British Journal of Anaesthesia, Vol 76, Issue 5 632-639, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Preoperative inhibition of angiotensin-converting enzyme improves systemic and renal haemodynamic changes during aortic abdominal surgery

M. Licker, M. Bednarkiewicz, P. Neidhart, R. Pretre, M. Montessuit, H. Favre and D. R. Morel
Division of Anaesthesiology, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland; Clinics of Cardiovascular Surgery, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland; Division of Nephrology, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland; Division of Anaesthesiological Investigations, University Hospital of Geneva, CH-1211 Geneva 14, Switzerland

We studied 22 patients undergoing aortic surgery, allocated randomly to receive, before induction of anaesthesia, a single i.v. dose of enalapril 50 micrograms kg-1 or saline. During infrarenal aortic cross- clamping, we observed similar reductions in oxygen uptake in the two groups, despite greater systemic oxygen delivery in enalapril-treated patients; angiotensin-converting enzyme inhibition prevented the reduction in cardiac output and attenuated the decrease in glomerular filtration. Changes in glomerular filtration secondary to aortic clamping were related positively to changes in renal plasma flow (r = 0.83 (saline group) and r = 0.65 (enalapril group)). Creatinine clearance on the first day after operation was significantly higher in the enalapril compared with the saline group. We conclude that enalapril pretreatment is effective in improving systemic oxygen delivery, renal plasma flow and glomerular filtration during aortic abdominal surgery.
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