PDE5 Inhibitor Anaesthetic Implications — FRCA Final MCQ

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ModeratePreoperative AssessmentPDE5 Inhibitor Anaesthetic ImplicationsFRCA Final

A 45-year-old man (ASA I, 85 kg) presents for elective laparoscopic cholecystectomy. He mentions taking sildenafil 50 mg last night for erectile dysfunction. What is the anaesthetic implication?

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Correct answer: A — No significant anaesthetic implications

Sildenafil (PDE5 inhibitor) potentiates the hypotensive effect of nitrates by enhancing the nitric oxide-cGMP pathway. GTN and other nitrates are contraindicated within 24 hours of sildenafil use (36-48 hours for tadalafil). However, for routine anaesthesia without anticipated need for GTN, there are no specific contraindications. Standard anaesthetic agents, including vasopressors (phenylephrine, metaraminol), are safe. The key is documenting PDE5 inhibitor use so that GTN is avoided if perioperative ischaemia occurs – use alternative anti-anginal therapy.

Reference: BNF – 2025 – Sildenafil interactions; RCOA – 2023 – Preoperative assessment