farmacología
farmacología cardiovascular 56 | frebrero de 2023 volumen y eventualmente utilizar diuréticos de asa o fluidos. Sin embargo, los datos retrospectivos sugieren que la prescripción intraoperatoria de diuréticos puede aumentar el riesgo de daño renal (16, 17). Inhibidores SGLT2 El uso de inhibidores del cotransportador de sodio-glucosa-2 (SGLT2) está aumentando, debido a los beneficios CV comprobados para pacientes con diabetes mellitus tipo 2 (DM), así como también en sujetos con IC y con insuficiencia renal. La cetoacidosis diabética euglucémica (CADE) es una complicación rara pero grave. Si bien la incidencia no aumentó significativamente con los SGLT2i en los diferentes ensayos clínicos de estos fármacos, existen reportes de casos de CADE después de una cirugía no cardíaca en pacientes que recibían SGLT2i. Por ello, se sugiere interrumpir los SGLT2i al menos 3 a 4 días antes de la cirugía programada y estar atento a los síntomas compatibles con CADE (eventualmente con determinación de cetonas) (18). Referencias bibliográficas • 1. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(24):2215-2245. doi:10.1161/CIR.0000000000000105. • 2. Juan Krauss, Fernando Botto, Luciano Lucas, Rodrigo Bagnati, Diego Arakaki, Patricia Avellana, Fernando Belcastro, Augusto Lavalle Cobo, Mario Racki. – Rev Argent Cardiol. 2016;84 (Suplemento 1) y Rev Argent Cardiol 2016;84:166-183 (Versión resumida). • 3. Batra G, Aktaa S, Wallentin L, Maggioni AP, Wilkinson C, Casadei B, et al. Methodology for the development of international clinical data standards for common cardiovascular conditions: European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart). Eur Heart J Qual Care Clin Outcomes 2021:qcab052. • 4. Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth 2018;121:706–721. • 5. Shiffermiller JF, Monson BJ, Vokoun CW, Beachy MW, Smith MP, Sullivan JN, et al. Prospective Randomized Evaluation of Preoperative Angiotensin-Converting Enzyme Inhibition (PREOP-ACEI). J Hosp Med 2018;13:661–667. • 6. Roshanov PS, Rochwerg B, Patel A, Salehian O, Duceppe E, Belley-Cote EP, et al. Withholding versus continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers before noncardiac surgery: an analysis of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN Prospective Cohort. Anesthesiology 2017;126:16–27. • 7. Hollmann C, Fernandes NL, Biccard BM. A systematic review of outcomes associated with withholding or continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before noncardiac surgery. Anesth Analg 2018;127:678–687. • 8. Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826-3924. doi:10.1093/eurheartj/ehac270. • 9. Poise Study Group, Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008;371:1839–1847. • 10. Blessberger H, Lewis SR, Pritchard MW, Fawcett LJ, Domanovits H, Schlager O, et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery. Cochrane Database Syst Rev 2019;9:CD013438. • 11. Kertai MD, Cooter M, Pollard RJ, Buhrman W, Aronson S, Mathew JP, et al. Is Compliance With Surgical Care Improvement Project Cardiac (SCIP-Card-2) measures for perioperative beta-blockers associated with reduced incidence of mortality and cardiovascular-related critical quality indicators after noncardiac surgery? Anesth Analg 2018;126:1829–1838. • 12. Wijeysundera DN, Beattie WS. Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: a meta-analysis. Anesth Analg 2003;97:634–641. • 13. Oesterle A, Weber B, Tung R, Choudhry NK, Singh JP, Upadhyay GA. Preventing postoperative atrial fibrillation after noncardiac surgery: a meta-analysis. Am J Med 2018;131:795–804 e795. • 14. London MJ, Schwartz GG, Hur K, Henderson WG. Association of perioperative statin use with mortality and morbidity after major noncardiac surgery. JAMA Intern Med 2017;177:231–242 • 15. Berwanger O, de Barros ESPG, Barbosa RR, Precoma DB, Figueiredo EL, Hajjar LA, et al. Atorvastatin for high-risk statin-naive patients undergoing noncardiac surgery: the Lowering the Risk of Operative Complications Using Atorvastatin Loading Dose (LOAD) randomized trial. Am Heart J 2017;184:88–96. • 16. Hager B, Betschart M, Krapf R. Effect of postoperative intravenous loop diuretic on renal function after major surgery. Schweiz Med Wochenschr 1996;126:666–673. • 17. Tagawa M, Ogata A, Hamano T. Pre- and/or intra-operative prescription of diuretics, but not renin-angiotensin-system inhibitors, is significantly associated with acute kidney injury after non-cardiac surgery: a retrospective cohort study. PLoS One 2015;10:e0132507. • 18. Thiruvenkatarajan V, Meyer EJ, Nanjappa N, Van Wijk RM, Jesudason D. Perioperative diabetic ketoacidosis associated with sodium-glucose co-transporter-2 inhibitors: a systematic review. Br J Anaesth 2019;123:27–36. EDITORIAL SCIENS // 7
