Cardiac Arrest during Total Hip Arthroplasty in a Patient on an Angiotensin Receptor Antagonist

Susan M. Goodman, MD
Assistant Attending Physician, Hospital for Special Surgery
Assistant Professor of Medicine, Weill Cornell Medical College

Daniel Krauser, MD
Hospital for Special Surgery


C. Ronald MacKenzie, MD

Attending Physician, Hospital for Special Surgery
Professor of Clinical Medicine, Weill Cornell Medical College
Professor of Clinical Public Health, Weill Cornell Medical College
Co-Medical Director, Center for Brachial Plexus and Traumatic Nerve Injury
Non-Operative Director, Spine Care Institute

Stavros G. Memtsoudis, MD, PhD

Attending Anesthesiologist, Hospital for Special Surgery
Clinical Professor of Anesthesiology, Weill Cornell Medical College
Clinical Professor of Public Health, Weill Cornell Medical College

Abstract

Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (ARA) are effective and well-tolerated first-line drugs in the therapy of hypertension and, therefore, are frequently encountered in the perioperative setting. Hemodynamic compensation for volume depletion seen in the perioperative period is normally mediated by the renin–angiotensin system, which is blocked by ACEI/ARA. These drugs may contribute to severe hypotension during anesthesia induction and may have contributed to the cardiac arrest seen in this patient. Additional factors such as increased intra-abdominal pressures and respiratory obstructive episodes leading to diminished venous return, as well diuretic use and the fasting state, common in the perioperative orthopedic patient, are likely to have contributed as well. Medication use may be an easily modifiable risk factor for severe hypotension and possible cardiac arrest in the perioperative setting.

This article appears in HSS Journal: Volume 8, Number 2.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


^ Back to Top
Request an Appointment