The main goal of this study was to explore this adaptation of a group of Mexican people with DS aged 12-30 years during the COVID-19 pandemic. We analyze the relationships among eight domains of executive function and mental and chronological age. The participants were 50 people with DS with a chronological age (CA) of 12-30 years and a mean mental age (MA) of 7 years. MA was evaluated with Raven’s Progressive Matrices test and executive function with the Behavior Rating Inventory of Executive Function (BRIEF-2); both were administered online. The Monitor, Emotional Control, Initiative, and Organization of Materials scales showed strengths, while Working Memory, Plan/Organize, Shift, and Inhibit showed weaknesses. CA correlated negatively with seven of the eight executive domains, while MA correlated negatively with two. Participants’ executive profile during the COVID-19 pandemic is consistent with that reported in previous research, and the findings are discussed in self-regulation process.

Importance

Before surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.

Objective

To evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.

Design, setting, and participants

Randomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.

Intervention

Patients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115).

Main outcomes and measures

The primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.

Results

Of the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.

Conclusions and relevance

Among patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.

Trial registration

ClinicalTrials.gov Identifier: NCT03374449.