A.11.

Does the choice of antihypertensive therapy influence hemodynamic

responses to induction, laryngoscopy, and intubation?

The pressor responses to induction, laryngoscopy, and intubation differ little whether patients with
mild to moderate hypertension receive a  –blocker, a calcium channel blocker, an ACE inhibitor, or a
diuretic. Even changes of a similar magnitude are also observed in untreated hypertensive patients.

A.12. Does chronic angiotensin-converting enzyme (ACE) inhibition influence

anesthetic induction?

Coriat et al. reported that, in hypertensive patients chronically treated with ACE inhibitors, therapy
until the day of surgery is a major factor influencing BP responsiveness to anesthetic induction for
vascular surgery. If enalapril (a long–acting ACE inhibitor) treatment is continued, a very low plasma–
converting enzyme activity will be observed and an exaggerated hypotensive response may occur at
induction. If captopril (a short–acting ACE inhibitor) treatment is continued, the magnitude of the
decrease in BP in response to induction, although lower than with enalapril, is enhanced compared
with that noted in patients in whom captopril had been stopped. All of the hypotensive episodes in
patients who received ACE inhibitors until the day of surgery were easily corrected by ephedrine
infusion. The temporary withdrawal of these two ACE inhibitors attenuated the hypotensive response
to induction but did not lead to an abnormal BP response to induction and intubation. However,
recently Ryckwaert and Colson reported that ACE inhibitor treatment in patients with infarction-
induced myocardial dysfunction does not increase the incidence of severe hypotension after induction
of anesthesia.