Impact of continuing or withholding blood pressure reducing drugs on the blood pressure stability and quality of recovery following day surgery procedures

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Ambulatory surgical procedures are increasingly being performed worldwide; patient complexities such as obesity, advanced age along with other medical conditions will be frequently encountered. Major perioperative morbidites or mortalities are reported to occur once in every 1000-day surgical cases according to a recent large review on approximately 250,000 cases. One of the significant predictors for adverse outcomes was hypertension. Increasing number of patients on ACEI and ARBs are seen undergoing day surgery procedures. While we have strong recommendations about preoperative beta-blockers, the evidence on these antihypertensives that act on the renin- angiotensin pathway is insufficient and controversial There is insufficient evidence on whether ACEI and ARBs should be continued or ceased before ambulatory surgeries. As there have been limited data in terms of recommendations on ACEI/ARB agonist in ambulatory surgeries, more research seems necessary to provide evidence on the risks of continuation these drugs, in terms of both high and low blood pressure responses. Primary aim: To investigate the association between i)Preoperative angiotensinogen converting enzyme inhibitor (ACEI) and ii)angiotensin II receptor blocker (ARB) therapy and perioperative blood pressure changes in patients undergoing ambulatory surgical procedures Secondary aim: 1. To study the haemodynamic influence of continuation of other antihypertensive agents. 2. To examine the effect of hemodynamic fluctuations on the quality of recovery and complication rates Following ethics committee approval, preoperative data from the consented patients that undergo day surgery procedures will be collected from patient records and face-to-face interview. Patients are allowed to follow their medication order as per the surgical/ anaesthetic teams’ instructions. No specific instruction on the antihypertensive treatment shall be given for this study. The preoperative data collected include but not limited to the antihypertensive therapy details and the time of last dose of medication. Management of the case will be left to the anaesthetic team involved. The details on the anaesthetic management, intraoperative hemodynamic changes and postoperative recovery details will be collected at the end of surgery. Endpoints measured: Primary: Significant hypotension b. Change in mean perioperative systolic blood pressure from mean pre-operative measures. c) Variability in systolic blood pressure d) Preoperative hypertensionSecondary outcomes: Length of stay in recovery room. Unplanned readmission or any major surgical or medical complications, quality of recovery within 24 hours of the day-surgery procedure, correlation between the primary outcome measures Vs type antihypertensive agents and the timing of discontinuation in patients on monotherapy.

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