[Perioperative Beta-receptor Blockade. For and Against]

Overview

Journal Anaesthesist

Specialty Anesthesiology

Date 2010 Apr 13

PMID 20383478

Citations 1

Authors

B Preckel

M Poels

F Wappler

W Schlack

W Buhre

Affiliations

Soon will be listed here.

Abstract

Results from recent studies have questioned the application of beta-receptor blockers for reduction of morbidity and mortality during the perioperative period. This holds true especially for patients with no or only low cardiac risk. Although beta-receptor blockade was a form of standard therapy at the end of the 1990s, data today show no clear evidence for such a therapy not even in patients at risk for cardiac events. At least in patients with low risk the initiation of beta-receptor blockade during the perioperative period might lead to side-effects, thereby increasing morbidity and mortality.

Citing Articles

[Perioperative risk stratification using biomarkers : science or fiction?].

Meybohm P Anaesthesist. 2011; 60(8):705-6.

PMID: 21830131 DOI: 10.1007/s00101-011-1929-5.

References

Devereaux P, Beattie W, Choi P, Badner N, Guyatt G, Villar J . How strong is the evidence for the use of perioperative beta blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005; 331(7512):313-21. PMC: 1183126. DOI: 10.1136/bmj.38503.623646.8F. View

Beattie W, Wijeysundera D, Karkouti K, McCluskey S, Tait G . Does tight heart rate control improve beta-blocker efficacy? An updated analysis of the noncardiac surgical randomized trials. Anesth Analg. 2008; 106(4):1039-48, table of contents. DOI: 10.1213/ane.0b013e318163f6a9. View

Brady A, Gibbs J, Greenhalgh R, Powell J, Sydes M . Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc Surg. 2005; 41(4):602-9. DOI: 10.1016/j.jvs.2005.01.048. View

Poldermans D, Bax J, Schouten O, Neskovic A, Paelinck B, Rocci G . Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control?. J Am Coll Cardiol. 2006; 48(5):964-9. DOI: 10.1016/j.jacc.2006.03.059. View

Urban M, Markowitz S, Gordon M, Urquhart B, Kligfield P . Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg. 2000; 90(6):1257-61. DOI: 10.1097/00000539-200006000-00001. View

Poldermans D, Boersma E, Bax J, Thomson I, van de Ven L, Blankensteijn J . The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med. 1999; 341(24):1789-94. DOI: 10.1056/NEJM199912093412402. View

Smith Jr S, Feldman T, Hirshfeld Jr J, Jacobs A, Kern M, King 3rd S . ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for.... Circulation. 2006; 113(7):e166-286. DOI: 10.1161/CIRCULATIONAHA.106.173220. View

Shammash J, Trost J, Gold J, Berlin J, Golden M, Kimmel S . Perioperative beta-blocker withdrawal and mortality in vascular surgical patients. Am Heart J. 2001; 141(1):148-53. DOI: 10.1067/mhj.2001.111547. View

. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999; 353(9146):9-13. View

10.

Miller D, Martineau R, Wynands J, Hill J . Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial. Can J Anaesth. 1991; 38(7):849-58. DOI: 10.1007/BF03036959. View

11.

Wiesbauer F, Schlager O, Domanovits H, Wildner B, Maurer G, Muellner M . Perioperative beta-blockers for preventing surgery-related mortality and morbidity: a systematic review and meta-analysis. Anesth Analg. 2006; 104(1):27-41. DOI: 10.1213/01.ane.0000247805.00342.21. View

12.

Dunkelgrun M, Boersma E, Schouten O, Koopman-van Gemert A, van Poorten F, Bax J . Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg. 2009; 249(6):921-6. DOI: 10.1097/SLA.0b013e3181a77d00. View

13.

Rinfret S, Abrahamowicz M, Tu J, Humphries K, Eisenberg M, Richard H . A population-based analysis of the class effect of beta-blockers after myocardial infarction. Am Heart J. 2007; 153(2):224-30. DOI: 10.1016/j.ahj.2006.11.008. View

14.

BLOMQVIST I, Westergren G, Sandberg A, Jonsson U, Lundborg P . Pharmacokinetics and pharmacodynamics of controlled-release metoprolol: a comparison with atenolol. Eur J Clin Pharmacol. 1988; 33 Suppl:S19-24. DOI: 10.1007/BF00578408. View

15.

Poole-Wilson P, Swedberg K, Cleland J, Lenarda A, Hanrath P, Komajda M . Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003; 362(9377):7-13. DOI: 10.1016/S0140-6736(03)13800-7. View

16.

Sear J, Giles J, Howard-Alpe G, Foex P . Perioperative beta-blockade, 2008: what does POISE tell us, and was our earlier caution justified?. Br J Anaesth. 2008; 101(2):135-8. DOI: 10.1093/bja/aen194. View

17.

Boersma E, Kertai M, Schouten O, Bax J, Noordzij P, Steyerberg E . Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med. 2005; 118(10):1134-41. DOI: 10.1016/j.amjmed.2005.01.064. View

18.

Fleischmann K, Beckman J, Buller C, Calkins H, Fleisher L, Freeman W . 2009 ACCF/AHA focused update on perioperative beta blockade: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation. 2009; 120(21):2123-51. DOI: 10.1161/CIRCULATIONAHA.109.192689. View

19.

Stanley W, Lopaschuk G, Hall J, McCormack J . Regulation of myocardial carbohydrate metabolism under normal and ischaemic conditions. Potential for pharmacological interventions. Cardiovasc Res. 1997; 33(2):243-57. DOI: 10.1016/s0008-6363(96)00245-3. View

20.

Landesberg G . Monitoring for myocardial ischemia. Best Pract Res Clin Anaesthesiol. 2005; 19(1):77-95. View