Which intravenous induction agent for patients with renin-angiotensin blockade? [Reni̇n anji̇yotensi̇n blokaji yapilan hastalarda hangi̇ i̇ntravenöz i̇ndüksi̇yon ajani?]

Aim: hypotension after induction of general anesthesia is a special consideration in hypertensive patients. in this study,we aimed to investigate the incidence of occurrence of hypotension after the induction of general anesthesia following administration of three different intravenous agents in patients who were being chronically treated with acei and/or ara. methods: ninety patients were enrolled in the study. blood pressures,demographic information and drug use,and the time pased after the last use of acei and/or ara dosage till the surgery were recorded. patients were randomized to three groups according to the anesthetic agents used during induction; propofol,etomidate,and thiopenthal,respectively. arterial blood pressure and heart rate values within the first 15 minutes of post-induction period and during extubation period were recorded. hypotension hot treated with position,bolus fluid infusion and ephedrine bolus administration,in case of no response. the frequency of hypotension and applied treatments were recorded. results: the systolic blood pressure (sbp) showed differences in the 4th and 10th minutes after induction. sbp was significantly lower in propofol and thiopenthal groups than in etomidate group in the 4th minute (p:0.003). sbp was significantly lower in the 10th minute in thiopental group than in other groups (p:0.007). diastolic and mean arterial pressure values of etomidate group were higher than the other groups. the frequency of hypotension was significantly higher in propofol group (p:0.049) 15 minutes after induction,but the treatment and the reaction to treatment were similar between groups. conclusion: the decrease observed in blood pressure hot higher in propofol group,compared to thiopental and etomidate groups for hypertensive patients who were being chronically treated with ras blocking agents,within the first 15 minutes after induction. we conclude that,for this patient group,anesthetic induction with thiopental,although partially,and etomidate are safer compared to propofol.