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ACE Inhibitor Morning of Surgery — FRCA Final MCQ

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ModeratePerioperative MedicineACE Inhibitor Morning of SurgeryFRCA Final

A 75-year-old man with hypertension on ramipril 10 mg daily is scheduled for elective TKR. Should the ACE inhibitor be continued on the morning of surgery?

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Correct answer: B — No — withhold ACE inhibitors on the morning of surgery

Current consensus (Association of Anaesthetists, RCOA): withhold ACE inhibitors and ARBs on the morning of surgery to reduce risk of refractory intraoperative hypotension. Continue other antihypertensives (beta-blockers, calcium channel blockers). Resume ACE-I postoperatively when eating and drinking and haemodynamically stable.

Reference: Association of Anaesthetists – 2023 – Perioperative management of cardiovascular medications