ACE Inhibitors and ARBs Before Surgery

CA-1 ·

27Sources
6Kept
0Dropped

1 · Find evidence

PubMed query

Every result is a real PMID returned by NCBI. Nothing on this step is generated.

Ask OpenEvidence ↗

OpenEvidence opens in your own logged-in session with the question filled in. Nothing is fetched on your behalf — read it there, then add what you want to teach as a point below, citing the source it came from.

27 candidate papers

Ticked papers are the ones a deck may be built from. Unticking one needs a reason — the citation gate proves a paper exists, and nothing but you decides whether it should be taught. A tier badge appears where the paper’s publication type is known.

Same-day build

PubMed query

Runs the tiered searches, drafts one point per included paper, runs the citation gate and builds a draft deck — the steps below, unattended. Same-day build — drafted locally (medgemma:27b), confirmed against each abstract. The deck still lands in draft: nothing here approves anything.

2 · Teaching points

Source

A point with no source will not survive the gate. That is the point of the gate.

6 points

Pooling 14 randomised trials, withholding ACE inhibitors or ARBs cut intraoperative hypotension from 48% to 36% and reduced vasopressor use, but raised postoperative hypertension from 20% to 28%, on very low certainty evidence. PMID 41017370 kept
Continuing renin-angiotensin system inhibitors to the day of surgery gave the same rate of death and major complications at 28 days as stopping them 48 hours before (22% in each arm), but hypotension during surgery rose from 41% to 54%. PMID 39212270 kept
In a 4,802-patient cohort, withholding an ACE inhibitor or ARB in the 24 hours before noncardiac surgery was associated with a lower risk of the composite of death, stroke or myocardial injury at 30 days. PMID 27775997 kept
ACE inhibitors attenuate sympathetic neurotransmission, particularly when endogenous renin-angiotensin activity is high. PMID 1382170 kept
Across 16 studies and 59,105 patients, withholding RAAS inhibitors lowered intraoperative hypotension and acute kidney injury but made no significant difference to mortality, major cardiac events, infarction or stroke. PMID 39531998 kept
In patients whose preoperative NT-proBNP was below 100 pg/mL, stopping RAS inhibitors before surgery raised myocardial injury from 23% to 40% — the harm of stopping is not uniform across risk groups. PMID 38341283 kept

Checks every citation against PubMed, the DOI resolver, or a live fetch. Points that do not resolve are dropped and shown to you with the reason — never quietly softened.

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5 · Question bank

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