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Canadian Journal of Anesthesia 54:157 (2007)
© Canadian Anesthesiologists' Society, 2007

Correspondence

REPLY

Grainne Nicholson, MB BS and George Hall, PhD

St George’s Hospital Medical School, London, UK, E-mail: gnichols{at}sgul.ac.uk

Thank you for the opportunity of replying to the letter of Dr. Adachi and colleagues.

Dr. Adachi and colleagues documented two cases of tongue edema in patients following cardiopulmonary bypass. Following exclusion of other possible precipitating causes, it was concluded that angioedema secondary to angiotensin converting enzyme inhibitor (ACEI) therapy was the most likely diagnosis. These two cases highlight some of the more interesting aspects of angioedema secondary to ACEI therapy discussed in our review.

Firstly, use of ACEI medication is increasing and clinicians will be faced with the complications of therapy. It is therefore important that they are aware of this potentially life threatening complication. Secondly, although theoretically angiotensin receptor blocker (ARB) drugs should not cause angioedema, these case reports emphasize that ARBs cannot be considered completely safe.1–3 Finally, it is unfortunate that there are no definitive symptoms or investigations to confirm the diagnosis which is based on a high index of suspicion and exclusion of other possible causes of angioedema. Clinical awareness of this potentially life threatening complication and prompt intervention remain the keys to successful management.

References

1 van Rijnsoever EW, Kwee-Zuiderwijk WJ, Feenstra J. Angioneurotic edema attributed to the use of losartan. Arch Intern Med 1998; 158: 2063–5.[Abstract/Free Full Text]

2 Chiu AG, Krowiak EJ, Deeb ZE. Angioedema associated with angiotensin II receptor antagonists: challenging our knowledge of angioedema and its etiology. Laryngoscope 2001; 111: 1729–31.[Medline]

3 Howes LG, Tran D. Can angiotensin receptor antagonists be used safely in patients with previous ACE inhibitorinduced angioedema? Drug Saf 2002; 25: 73–6.[Medline]


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