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Case Reports in Anesthesiology
Volume 2013, Article ID 723815, 5 pages
Case Report

Multifactorial Model and Treatment Approaches of Refractory Hypotension in a Patient Who Took an ACE Inhibitor the Day of Surgery

1Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
2Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
3University of Miami Leonard M. Miller School of Medicine and DeWitt Daughtry Family Department of Surgery, Division of Endocrine Surgery, University of Miami and Jackson Memorial Hospitals, 1120 NW 14th Street, CRB-Room 410P (M-875), Miami, FL 33136, USA

Received 18 February 2013; Accepted 11 March 2013

Academic Editors: D. Lee and J.-J. Yang

Copyright © 2013 Karan Srivastava et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


In the field of anesthesiology, there is wide debate on discontinuing angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy the day of noncardiac surgery. Although there have been many studies attributing perioperative hypotension to same-day ACEI and ARB use, there are many additional variables that play a role in perioperative hypotension. Additionally, restoring blood pressure in these patients presents a unique challenge to anesthesiologists. A case report is presented in which a patient took her ACEI the day of surgery and developed refractory hypotension during surgery. The evidence of ACEI use on the day of surgery and development of hypotension is reviewed, and additional variables that contributed to this hypotensive episode are discussed. Lastly, current challenges in restoring blood pressure are presented, and a basic model on treatment approaches for refractory hypotension in the setting of perioperative ACEI use is proposed.