Preoperative assessment: ACE inhibitors: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Preoperative assessment: ACE inhibitors

Sample item

Why are ACE inhibitors and angiotensin receptor blockers often omitted on the morning of surgery?

AThey are associated with refractory hypotension after inductionBThey cause hyperglycaemiaCThey prolong neuromuscular blockDThey cause bronchospasm during intubation

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. They are associated with refractory hypotension after induction

RAAS blockers blunt the compensatory response to vasodilation caused by anaesthetic agents, so hypotension after induction can be profound and resistant to ephedrine. Many centres withhold them for 24 hours before surgery.

Option by option

A. They are associated with refractory hypotension after induction (correct)
Correct. Intraoperative hypotension is the concern.
B. They cause hyperglycaemia
They do not cause hyperglycaemia.
C. They prolong neuromuscular block
They do not significantly affect neuromuscular blockers.
D. They cause bronchospasm during intubation
Cough is a side effect of ACE inhibitors but bronchospasm during intubation is not the reason for holding them.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, They are associated with refractory hypotension after induction. RAAS blockers blunt the compensatory response to vasodilation caused by anaesthetic agents, so hypotension after induction can be profound and resistant to ephedrine.

Why is "They cause hyperglycaemia" not the answer?

They do not cause hyperglycaemia.

Why is "They prolong neuromuscular block" not the answer?

They do not significantly affect neuromuscular blockers.

Why is "They cause bronchospasm during intubation" not the answer?

Cough is a side effect of ACE inhibitors but bronchospasm during intubation is not the reason for holding them.

What concept does this question test?

It tests Preoperative assessment: ACE inhibitors in Anaesthesia. Many centres withhold them for 24 hours before surgery.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Preoperative assessment: ACE inhibitors?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.