Summary
Beta-adrenergic receptor blockade may have extensive use in clinical medicine. Interactions between beta-adrenergic blocking drugs and anaesthetic agents may have life-threatening ramifications and sequelae. Physiological responses to anaesthetic agents which stimulate sympatho-adrenal activity may be altered markedly.
Beta-adrenergic blocking agents are contraindicated in patients with atrio-ventricular block and idioventricular rhythm, because all cardiac electrical activity may be abolished. Relative contraindications include asthma and other broncho-spastic states and conditions predisposing towards hypoglycaemia, e.g. insulin-treated diabetes mellitus.
Anaesthetized patients subjected to beta-adrenergic blockade will have decreased tolerance to any factor that increases cardiac work. Patients with hearts dependent upon sympathetic support for survival will not tolerate removal of that support, regardless of anaesthetic agent superimposed.
Without beta-adrenergic support, evidence of falling cardiac output will be manifested as hypotension and bradycardia. Central venous pressure will rise if the myocardium fails.
RéSUMé
Le blocage des récepteurs bêta adrénergiques peut être largement utilisé en clinique. Des actions réciproques entre les médicaments qui bloquent ces récepteurs et les agents anesthésiques peuvent provoquer des séquelles dangereuses pour la vie. Les réponses physiologiques aux agents anesthésiques qui stimulent l’activité sympathico-surrénalienne peuvent être sensiblement affectées.
Les agents qui bloquent les récepteurs bêta-adrénergiques sont contre-indiqués chez les sujets souffrant d’un bloc auriculo-ventriculaire d’un rythme idioventriculaire, parce que toute activité électrique du cœur peut être abolie. Parmi les contre-indications relatives, on relève l’asthme et les autres conditions broncho-spasmatiques qui prédisposent à l’hypogrycémie, par exemple les cas de diabète traités à l’insuline.
Chez les malades anesthésiés soumis à un blocage des récepteurs bêta-adrénergiques, on verra apparaître une baisse du débit cardiaque en même temps qu’une hypotension et une bradycardie. La pression veineuse centrale augmentera si le myocarde défaille.
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Besterman, E. M. M. &Friedlander, D. H. Clinical Experiences with Propranolol. Postgrad. Med. J.41: 526 (1965).
Dornhorst, A. C. &Robinson, B. F. Clinical Pharmacology of a Beta-Adrenergic-Blocking Agent (Nethalide). Lancet.2: 314 (1962).
Dornhorst, A. C. Adrenergic Blockade in Cardiovascular Disease. Pharmacol. Rev.18: 701 (1966).
Gillam, P. M. S. &Prichard, B. N. C. Propranolol in the Therapy of Angina Pectoris. Amer. J. Cardiol.18: 366 (1966).
Gillam, P. M. S. &Prichard, B. N. C. Use of Pxopranolol in Angina Pectoris. Brit. Med. J.2: 337 (1965).
Grant, R. H. E.;Keelan, P.;Kernohan, R. J.;Leonard, J. C.;Nancekievill, L.; &Sinclair, K. Multicenter Trial of Propranolol in Angina Pectoris. Am. J. Cardiol.18: 361 (1966).
Hamer, J. &Sowton, E. Effects of Propranolol on Exercise Tolerance in Angina Pectoris. Am. J. Cardiol.18: 354 (1966).
Rabkin, R.;Stables, D. P.;Levin, N. W.; &Suzman, M. M. The Prophylactic Value of Propranolol in Angina Pectoris. Am. J. Cardiol.18: 370 (1966).
Wolfson, S., Heinle, R. A.;Herman, M. V.;Kemp, H. G.;Sullivan, J. M.; &Gorlin, R. Propranolol and Angina Pectoris. Am. J. Cardiol.18: 345 (1966).
Bath, J. C. J. L. Treatment of Cardiac Arrhythmias in Unanesthetized Patients: Role of Adrenergic Beta Receptor Blockade. Amer. J. Cardiol.18: 415 (1966).
Harris, A. Long Term Treatment of Paroxysmal Cardiac Arrhythmias with Propranolol. Am. J. Cardiol.18: 431 (1966).
Rowlands, D. J.;Howitt, G.; &Markiman, P. Propranolol (Inderal) in Disturbances of Cardiac Rhythm. Brit. M. J.1: 891 (1965).
Sloman, G.;Robinson, J. S.; &McLean, K. Propranolol (Inderal) in Persistent Ventricular Fibrillation. Brit. M. J.1: 895 (1965).
Stock, J. P. P. Beta Adrenergic Blocking Drugs in the Clinical Management of Cardiac Arrhythmias. Am. J. Cardiol.18: 444 (1966).
Stock, J. P. P. &Dale, N. Beta-Adrenergic Receptor Blockade in Cardiac Arrhythmias. Brit. M. J.2: 1230 (1963).
Szekely, P.;Jackson, F.;Wynne, N. A.;Vohra, J. K.;Batson, G. A.; &Dow, W. M. Clinical Observations on the Use of Propranolol in Disorders of Cardiac Rhythm. Am. J. Cardiol.18: 426 (1966).
Turner, J. R. B. Propranolol in the Treatment of Digitalis-Induced and Digitalis-Resistant Tachycardias. Am. J. Cardiol.18: 450 (1966).
Vaughn Williams, E. M. &Sekiya, A. Prevention of Arrhythmias Due to Cardiac Glycosides by Block of Sympathetic β-Receptors. Lancet.1: 420 (1963).
Cherian, G.;Brockington, I. F.;Shah, P. M.;Oakley, C. M.; &Goodwin, J. F. Beta Adrenergic Blockade in Hypertrophic Obstructive Cardiomyopathy. Am. J. Cardiol.18: 481 (1966).
Epstein, S. E. &Braunwald, E. Beta-Adrenergic Receptor Blocking Drugs: Mechanisms of Action and Clinical Applications. New England J. Med.275: 1106 (1966).
Buist, N. R.;Mijer, F.; &O’Brien, D. Treatment of a Pheochromocytoma with a Beta-Adrenergic Blocking Agent. Arch Dis. Child.41: 435 (1966).
Dornhorst, A. C. &Laurence, D. R. Use of Pronethalol in Phaeochrome Tumours. Brit. Med. J.2: 1250 (1963).
Prichard, B. N. C. &Ross, E. J. Use of Propranolol in Conjunction with Alpha Receptor Blocking Drugs in Pheochromocytoma. Am. J. Cardiol.18: 394 (1966).
Paterson, J. W. &Dollery, C. T. Effect of Propranolol in Mild Hypertension. Lancet.2: 1148 (1966).
Prichard, B. N. C. &Gillam, P. M. S. Propranolol in Hypertension. Am. J. Cardiol.28: 387 (1966).
Brewster, W. R.;Isaacs, J. P.; &Andersen, T. W. Depressant Effect of Ether on Myocardium of Dog and Its Modification by Reflex Release of Epinephrine and Norepinephrine. Am. J. Physiol.175: 399 (1953).
Price, H. L.;Linde, H. W.;Jones, R. E.;Black, G. W.; &Price, M. L. Sympatho-Adrenal Responses to General Anesthesia in Man and Their Relation to Hemodynamics. Anesthesiology.20: 563 (1959).
Langley, J. N. On the Reaction of Cells and of Nerve-Endings to Certain Poisons, Chiefly as Regards to the Reaction of Striated Muscle to Nicotine and to Curari. J. Physiol. (London).33: 374 (1905).
Dale, H. H. On Some Physiological Actions of Ergot. J. Physiol. (London).34: 163 (1906).
Ahlquist, R. P. A Study of Adrenotropic Receptors. Am. J. Physiol.153: 586 (1948).
Moran, N. C. &Perkins, M. E. Adrenergic Blockade of the Mammalian Heart by a Dichloro Analogue of Isoproterenol. J. Pharmacol. Exper. Therap.124: 223 (1958).
Furchcott, R. F. The Receptors for Epinephrine and Norepinephrine (Adrenergic Receptors). Pharmacol. Rev.11: 429 (1959).
Powell, C. E. &Slater, I. H. Blocking of Inhibitory Adrenergic Receptors by a Dichloro Analog of Isoproterenol. J. Pharmacol. Exper. Therap.122: 480 (1958).
Dresel, P. E. Blockade of Some Cardiac Actions of Adrenaline by Dichloroisoproterenol. Canad. J. Biochem. Physiol.38: 375 (1960).
Black, J. W. &Stephenson, J. S. Pharmacology of a New Adrenergic Beta-Receptor-Blocking Compound (Nethalide). Lancet.2: 311 (1962).
Paget, G. E. Carcinogenic Action of Pronethalol. Brit. M. J.2: 1266 (1963).
Black, J. W.;CRowther, A. F.;Shanks, R. G.;Smith, L. H.; &Dornhorst, A. C. A New Adrenergic Beta-Receptor Antagonist. Lancet.1: 1080 (1964).
Shanks, R. G. The Pharmacology of Beta Sympathetic Blockade. Am. J. Cardiol.18: 308 (1966).
Ariens, E. J. &Simonis, A. M. A Molecular Basis for Drug Action. J. Pharm. & Pharmacol.16: 137 (1964).
Shanks, R. G. The Effect of Propranolol on the Cardiovascular Responses to Isoprenaline, Adrenaline and Noradrenaline in the Anaesthetized Dog. Brit. J. Pharmacol.26: 322 (1966).
Flacke, J. W.;Osgood, P. F.; &Bendixen, H. H. Actions of Propranolol and Isoproterenol in Blocked Dogs. Fed. Proc.25: 471 (1966).
Mahon, W. A. The Hemodynamic Effects of Beta Adrenergic Blockade in Man. Clin. Res. Proc. 13: 213 (1965).
Nakano, J. &Kusakari, T. Effect of Beta Adrenergic Blockade on the Cardiovascular Dynamics. Am. J. Physiol.210: 833 (1966).
Black, J. W.;Duncan, W. A. M.; &Shanks, R. G. Comparison of Some Properties of Pronethalol and Propranolol. Brit. J. Pharmacol.25: 577 (1965).
Moran, N. C. Pharmacological Characterization of Adrenergic Receptors. Pharmacol. Rev.18: 503 (1966).
Sowton, E. &Hamer, J. Hemodynamic Changes after Beta Adrenergic Blockade. Am. J. Cardiol.18: 317 (1966).
Sonnenblick, E. H.;Braunwald, E.;Williams, J. F., Jr.; &Glick, G. Effects of Exercise on Myocardial Force-Velocity Relations in Intact Unanesthetized Man: Relative Roles of Changes in Heart Rate, Sympathetic Activity and Ventricular Dimensions. J. Clin. Invest.44: 2051 (1965).
Chamberlain, D. A. Effects of Beta Adrenergic Blockade on Heart Size. Am. J. Cardiol.18: 321 (1966).
Robinson, B. F.;Epstein, S. E.;Beiser, G. D.; &Braunwald, E. Control of Heart Rate by the Autonomic Nervous System: Studies in Man on the Interrelation between Baroreceptor Mechanisms and Exercise. Cir. Res.19: 400 (1966).
Epstein, S. E.;Robinson, B. F.;Kahler, R. L.; &Braunwald, E. Effects of Beta- Adrenergic Blockade on the Cardiac Response to Maximal and Submaximal Exercise in Man. J. Clin. Invest.44: 1745 (1965).
MacDonald, H. R.;Sapru, R. P.;Taylor, S. H.; &Donald, K. W. Effect of Intravenous Propranolol on the Systemic Circulatory Response to Sustained Handgrip. Amer. J. Cardiol.18: 333 (1966).
Brick, I.;Glover, W. E.;Hutchison, K. J.; &Roddie, I. C. Effects of Propranolol on Peripheral Vessels in Man. Am. J. Cardiol.18: 329 (1966).
Johnstone, M. Beta-Adrenergic Blockade with Pronethalol during Anaesthesia. Brit. J. Anaesth.36: 224 (1964).
Johnstone, M. Propranolol (Inderal) during Halothane Anaesthesia. Brit. J. Anaesth.38: 516 (1966).
Johnstone, M. Propranolol in Anesthesia. Am. J. Cardiol.18: 479 (1966).
Payne, J. P. &Senfield, R. M. Pronethalol in the Treatment of Ventricular Arrhythmias during Anaesthesia. Brit. M. J.1: 603 (1964).
Sharma, P. L. Effect of Propranolol on Catecholamine-Induced Arrhythmias during Nitrous Oxide-Halothane Anaesthesia in the Dog. Brit. J. Anaesth.38: 871 (1966).
Vetten, K. B. &Kündig, H. Clinical Observations on Some Pharmacological Properties of Pronethalol, a Beta-Receptor Blocker with Special Reference to Anaesthesia. Med. Proc.11: 417 (1965).
Snow, P. J. D. Effect of Propranolol in Myocardial Infarction. Lancet.2: 551 (1965).
Stephen, S. A. Propranolol in Acute Myocardial Infarction. A Multicentre Trial. Lancet.2: 1435 (1966).
Benfey, B. G. &VaRma, D. R. Antisympathomimetic and Antifibrillatory Effects of Pronethalol and Propranolol. Brit. J. Pharmacol.26: 3 (1966).
Rouse, W. Effects of Propranolol and Ouabain on the Conducting System of the Heart in Dogs. Am. J. Cardiol.18: 406 (1966).
Sekiya, A. &Vaughn Williams, E. M. The Effects of Pronethalol, Dichloroisoprenaline and Disopyramide on the Toxicity to the Heart of Ouabain and Anaesthetics. Brit. J. Pharmacol.21: 462 (1963).
— A Comparison of the Antifibrillatory Actions and Effects on Intracellular Cardiac Potentials of Pronethalol, Disopyramide and Quinidine. Brit. J. Pharmacol.21: 473 (1963).
Vaughn Williams, E. M. Mode of Action of Beta Receptor Antagonists on Cardiac Muscle. Am. J. Cardiol.18: 399 (1966).
Nickerson, M. &Nomaguchi, G. M. Mechanism of Dibenamine Protection against Cyclopropane-Epinephrine Cardiac Arrhythmias. J. Pharmacol. Exper. Therap.95: 1 (1949).
Eckstein, R. W.;Stroud, M.;Eckel, R.;Dowling, C. V.; &Pritchard, W. H. Effects of Control of Cardiac Work upon Coronary Flow and O2 Consumption after Sympathetic Nerve Stimulation. Am. J. Physiol.163: 539 (1950).
Parratt, J. R. &Grayson, J. Myocardial Vascular Reactivity after Beta-Adrenergic Blockade. Lancet.1: 338 (1966).
Gaal, P. G.;Kattus, A. A.;Kolin, A.; &Ross, G. Effects of Adrenaline and Noradrenaline on Coronary Blood Flow before and after Beta-Adrenergic Blockade. Brit. J. Pharmacol.26: 713 (1966).
Pitt, B.;Elliot, E. C.; &Gregg, D. E. Hemodynamic Effects of Catecholamines on the Coronary Circulation in the Unanesthetized Dog. Fed. Proc.25: 401 (1966).
Craythorne, N. W. B. &Huffincton, P. E. Effects of Propranolol on the Cardiovascular Responses to Cyclopropane and Halothane. Anesthesiology.27: 580 (1966).
Hellewell, J. &Potts, M. W. Propranolol and Ventricular Arrhythmias with Halothane. Anaesthesia.20: 269 (1965).
Katz, R. L. Effect of Alpha and Beta Adrenergic Blocking Agents on Cyclopropane-Catecholamine Cardiac Arrhythmias. Anesthesiology.26: 289 (1965).
Szekeres, L.;Papp, J.; &Förster, W. The Action of Adrenergic ß-Receptor Blocking Agents on Susceptibility to Cardiac Arrhythmias in Hypothermia and Hypoxia. Experientia.21: 720 (1965).
Anton, A. H.;Gravenstein, J. S.; &Wheat, M. W., Jr. Extracorporeal Circulation and Endogenous Epinephrine and Norepinephrine in Plasma, Atrium and Urine in Man. Anesthesiology.25: 262 (1964).
Leszkovsky, G. &Tardos, L. Some Effects of Propranolol on the Central Nervous System. J. Pharm. Pharmacol.10: 518 (1965).
Granville-Grossman, K. L. &Turner, P. The Effect of Propranolol on Anxiety. Lancet.1: 788 (1966).
Clark, W. G. &Vivonia, C. A. Central and Peripheral ß-Receptor Effects of Four ß-Adrenergic Blocking Drugs. Fed. Proc.26: 402 (1967).
Gill, E. W. &Vaughn Williams, E. M. Local Anaesthetic Activity of die Beta Receptor Antagonist, Pronethalol. Nature.201: 199 (1964).
Morales-Aquilera, A. &Vaughn Williams, E. M. The Effects on Cardiac Muscle of ß-Receptor Antagonists in Relation to Their Activity as Local Anaesthetics. Brit. J. Pharmacol.24: 332 (1965).
Andersen, N. B. &Gravenstein, J. S. Effects of Local Anesthetics on Sodium and Potassium in Human Red Cells. J. Pharmacol. Exper. Therap.147: 40 (1965).
Shanes, A. M. Electrochemical Aspects of Physiological and Pharmacological Action in Excitable Cells. Part I. The Resting Cell and Its Alteration by Extrinsic Factors. Pharmacol. Rev.10: 59 (1958).
Anderson, N. B. Personal communication.
Andersen, N. B. Effect of General Anesthetics on Sodium Transport in the Isolated Toad Bladder. Anesthesiology.27: 304 (1966).
Hellewell, J. &Potts, M. W. Propranolol during Controlled Hypotension. Brit. J. Anaesth.38: 794 (1966).
Vickers, M. D. Adrenergic Drugs and Their Antagonists in Anaesthesia. Brit. J. Anaesth.38: 728 (1966).
Jose, A. D. Effect of Combined Sympathetic and Parasympathetic Blockade on Heart Rate and Cardiac Function in Man. Am. J. Cardiol.18: 476 (1966).
Goodman, L. S. &Gilman, A. The Pharmacological Basis of Therapeutics. 3rd ed., New York: Macmillan (1965), p. 523.
Mazzia, V. D. B.;Ellis, C. H.;Siegal, H.; &Hershey, S. G. The Electrocardiograph as a Monitor of Cardiac Function in the Operating Room. J.A.M.A.198: 103 (1966).
Sarnoff, S. J. &Berglund, E. Ventricular Function: 1. Starling’s Law of the Heart Studied by Means of Simultaneous Right and Left Ventricular Function Curves in the Dog. Circulation.9: 706 (1954).
Eckstein, J. W. &Horsley, A. W. The Effects of Reduced Cardiac Sympathetic Tone on Myocardial Function. J. Clin. Invest.40: 555 (1961).
Sarnoff, S. J. Certain Aspects of the Role of Catecholamines in Circulatory Regulation. Am. J. Cardiol.5: 579 (1960).
Richardson, D. W.;Kontos, H. A.;Raper, A. J.; &Patterson, J. L., Jr. Modification by ß-Adrenergic Blockade of Circulatory Responses to Acute Hypoxia in Man. J. Clin. Invest.46: 77 (1967).
Stephen, S. A. Unwanted Side Effects of Propranolol. Am. J. Cardiol.18: 463 (1966).
McNeill, R. S. &Ingram, C. G. Effect of Propranolol on Ventilatory Function. Am. J. Cardiol.18: 473 (1966).
Goodman, L. S. &Gilman, A. The Pharmacological Basis of Therapeutics. 3rd ed., New York: Macmillan (1965), p. 618.
Abramson, E. A.;Arky, R. A.; &Woeber, K. A. Effects of Propranolol on the Hormonal and Metabolic Responses to Insulin-induced Hypoglycaemia. Lancet.2: 1386 (1966).
Kotler, M. N.;Berman, L.; &Rubenstein, A. H. Hypoglycaemia Precipitated by Propranolol. Lancet.2: 1389 (1966).
KakO, K.;Krayenbühl, H. P.;Lüthy, E.; &Hegglin, R. Cardiovascular Effects of Catecholamines in Dogs before and after Beta-Adrenergic Blockade. Arch. Pharm. Exp. Path.246: 297 (1964).
Vaughn Williams, E. M. &Szekeres, L. A Comparison of Tests for Anti-Fibrillatory Action. Brit. J. Pharmacol.17: 424 (1961).
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Warner, W.A. Beta-Adrenergic blocking agents and anaesthesia: a review. Canad. Anaesth. Soc. J. 15, 42–55 (1968). https://doi.org/10.1007/BF03005868
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DOI: https://doi.org/10.1007/BF03005868