Skip to main content
SpringerLink
Log in

Perioperative Beta-Blockade: Myths and Realities

  • Conference paper
Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.

  • 933 Accesses

Abstract

In 1997, the American College of Physicians published a guideline for assessing and managing patients with coronary artery disease who undergo major noncardiac surgery [1]. An important recommendation was that all eligible patients should receive a beta-blocker (atenolol).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Palda VA, Detsky AS (1997) Perioperative assessment and management of risk from coronary artery disease. Ann Intern Med 127:313–328

    PubMed  CAS  Google Scholar 

  2. Mangano DT (1995) Preoperative risk assessment: many studies, few solutions. Is a cardiac risk assessment paradigm possible? Anesthesiology 83:897–901

    Article  PubMed  CAS  Google Scholar 

  3. ISIS-1 (1986) Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group. Lancet 2:57–66

    Google Scholar 

  4. Owen A (1998) Intravenous beta blockade in acute myocardial infarction. Should be used in combination with thrombolysis. Br Med J 317:226–227

    CAS  Google Scholar 

  5. NCEPOD (2001) Then and Now: The 2000 Report of the National Confidential Enquiry into Perioperative Deaths: The National Confidential Enquiry into Perioperative Deaths

    Google Scholar 

  6. NCEPOD (1999) Extremes of Age. The 1999 Report of the National Confidential Enquity into Perioperative Deaths: The National Confidential Enquiry into Perioperative Deaths

    Google Scholar 

  7. Lee TH, Marcantonio ER, Mangione CM et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100:1043–1049

    PubMed  CAS  Google Scholar 

  8. Boersma E, Kertai MD, Schouten O et al (2005) Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 118:1134–1141

    Article  PubMed  Google Scholar 

  9. Mangano DT (1998) Adverse outcomes after surgery in the year 2001 — a continuing odyssey. Anesthesiology 88:561–564

    Article  PubMed  CAS  Google Scholar 

  10. Poldermans D, Boersma E, Bax JJ et al (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. N Engl J Med 341:1789–1794

    Article  PubMed  CAS  Google Scholar 

  11. Mamode N, Docherty G, Lowe GD et al (2001) The role of myocardial perfusion scanning, heart rate variability and D-dimers in predicting the risk of perioperative cardiac complications after peripheral vascular surgery. Eur J Vasc Endovasc Surg 22:499–508

    Article  PubMed  CAS  Google Scholar 

  12. Mangano DT, Browner WS, Hollenberg M et al (1992) Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group. JAMA 268:233–239

    Article  PubMed  CAS  Google Scholar 

  13. Eagle KA, Berger PB, Calkins H et al (2002) ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery — executive summary. J Am Coll Cardiol 39:542–553

    Article  PubMed  Google Scholar 

  14. McFalls EO, Ward HB, Moritz TE et al (2004) Coronary-artery revascularization before elective major vascular surgery. N Engl JMed 351:2795–2804

    Article  CAS  Google Scholar 

  15. Grayburn PA, Hillis LD (2003) Cardiac events in patients undergoing noncardiac surgery: shifting the paradigm from noninvasive risk stratification to therapy. Annals Int Med 138:506–511

    Google Scholar 

  16. Ohtsuka T, Hamada M, Hiasa G et al (2001) Effect of beta-blockers on circulating levels of inflammatory and anti-inflammatory cytokines in patients with dilated cardiomyopathy. J Am Coll Cardiol 37:412–417

    Article  PubMed  CAS  Google Scholar 

  17. Vallance P, Collier J, Bhagat K (1997) Infection, inflammation, and infarction: does acute endothelial dysfunction provide a link? Lancet 349:1391–1392

    Article  PubMed  CAS  Google Scholar 

  18. Pepine CJ, Cohn PF, Ellenbogen KA (1994) Advisory Group reports on silent myocardial ischemia, coronary atherogenesis, and cardiac emergencies. Council for Myocardial Ischemia and Infarction. Am J Cardiol 73:39B–44B

    Article  PubMed  CAS  Google Scholar 

  19. Feringa HH, Bax JJ, Schouten O et al (2006) Beta-blockers improve in-hospital and long-term survival in patients with severe left ventricular dysfunction undergoing major vascular surgery. Eur J Vasc Endovasc Surg 31:351–358

    Article  PubMed  CAS  Google Scholar 

  20. Carlberg B, Samuelsson O, Lindholm LH (2004) Atenolol in hypertension: is it a wise choice? Lancet 364:1684–1689

    Article  PubMed  CAS  Google Scholar 

  21. NICE (2006) Hypertension: management of hypertension in adults in primary care, partial update of NICE clinical guideline 18. National Institute for Health and Clinical Excellence clinical guideline 34

    Google Scholar 

  22. Ayescue Q, Brown B, Fabian L et al (1972) The experts opine. Survey Anesthesiol 16:484–487

    Google Scholar 

  23. Prys-Roberts C, Foex P, Biro GP, Roberts JG (1973) Studies of anaesthesia in relation to hypertension. V. Adrenergic beta-receptor blockade. Br J Anaesth 45:671–681

    Article  PubMed  CAS  Google Scholar 

  24. Stone JG, Foex P, Sear JW et al (1988) Myocardial ischemia in untreated hypertensive patients: effect of a single small oral dose of a beta-adrenergic blocking agent. Anesthesiology 68:495–500

    PubMed  CAS  Google Scholar 

  25. Wallace A, Layug B, Tateo I et al (1998) Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 88:7–17

    Article  PubMed  CAS  Google Scholar 

  26. Pasternack PF, Imparato AM, Baumann FG et al (1987) The hemodynamics of beta-blockade in patients undergoing abdominal aortic aneurysm repair. Circulation 76:III1–7

    PubMed  CAS  Google Scholar 

  27. Yeager RA, Moneta GL, Edwards JM et al (1995) Reducing perioperative myocardial infarction following vascular surgery. The potential role of beta-blockade. Arch Surg 130:869–872; discussion 872–873

    PubMed  CAS  Google Scholar 

  28. Mangano DT, Layug EL, Wallace A, Tateo I (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335:1713–1720

    Article  PubMed  CAS  Google Scholar 

  29. Poldermans D, Boersma E, Bax JJ et al (2001) Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery. Eur Heart J 22:1353–1358

    Article  PubMed  CAS  Google Scholar 

  30. Roizen MF (1988) Should we all have a sympathectomy at birth? Or at least preoperatively? Anesthesiology 68:482–484

    Article  PubMed  CAS  Google Scholar 

  31. Devereaux PJ, Beattie WS, Choi PT et al (2005) How strong is the evidence for the use of perioperative beta blockers in non-cardiac surgery? Systematic review and metaanalysis of randomised controlled trials. Br Med J 331:313–321

    Article  CAS  Google Scholar 

  32. Wiesbauer F, Schlager O, Domanovits H et al (2007) Perioperative beta-blockers for preventing surgery-related mortality and morbidity: a systematic review and metaanalysis. Anesth Analg 104:27–41

    Article  PubMed  CAS  Google Scholar 

  33. Raby KE, Brull SJ, Timimi F et al (1999) The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg 88:477–482

    Article  PubMed  CAS  Google Scholar 

  34. Feringa HH, Bax JJ, Boersma E et al (2006) High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients. Circulation 114:1344–1139

    Article  CAS  Google Scholar 

  35. Auerbach AD, Goldman L (2002) Beta-Blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA 287:1435–1444

    Article  PubMed  CAS  Google Scholar 

  36. Stevens RD, Burri H, Tramer MR (2003) Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg 97:623–633

    Article  PubMed  Google Scholar 

  37. Lindenauer PK, Pekow P, Wang K et al (2005) Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 353:349–361

    Article  PubMed  CAS  Google Scholar 

  38. Biccard BM, Sear JW, Foex P (2006) Acute peri-operative beta blockade in intermediate-risk patients. Anaesthesia 61:924–931

    Article  PubMed  CAS  Google Scholar 

  39. Fleisher LA, Beckman JA, Brown KA et al (2006) ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy. Circulation 113:2662–2674

    Article  PubMed  Google Scholar 

  40. Yang H, Raymer K, Butler R et al (2006) The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 152:983–990

    Article  PubMed  CAS  Google Scholar 

  41. Brady AR, Gibbs JS, Greenhalgh RM et al (2005) Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized doubleblind controlled trial. J Vasc Surg 41:602–609

    Article  PubMed  CAS  Google Scholar 

  42. Devereaux PJ, Yang H, Guyatt GH et al (2006) Rationale, design, and organization of the PeriOperative ISchemic Evaluation (POISE) trial: a randomized controlled trial of metoprolol versus placebo in patients undergoing noncardiac surgery. Am Heart J 152:223–230

    Article  PubMed  CAS  Google Scholar 

  43. Shojania K, Duncan B, McDonald K (2001) Making health care safer: a critical analysis of patients safety practices. In: Quality AfHRa, ed. Rockville (Maryland)

    Google Scholar 

  44. London MJ (2007) Con: Beta-blockers are indicated for all adults at increased risk undergoing noncardiac surgery. Anesth Analg 104:11–14

    Article  PubMed  CAS  Google Scholar 

  45. Fleisher LA (2007) Perioperative beta-blockade: how best to translate evidence into practice. Anesth Analg 104:1–3

    Article  PubMed  Google Scholar 

  46. Hoeks SE, Scholte Op Reimer WJ, van Urk H et al (2007) Increase of l-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg 33:13–19

    Article  PubMed  CAS  Google Scholar 

  47. Lanfear DE, Jones PG, Marsh S et al (2005) Beta2-adrenergic receptor genotype and survival among patients receiving beta-blocker therapy after an acute coronary syndrome. JAMA 294:1526–1533

    Article  PubMed  CAS  Google Scholar 

  48. Zaugg M, Bestmann L, Wacker J et al (2007) Adrenergic receptor genotype but not perioperative bisoprolol therapy may determine cardiovascular outcome in at-risk patients undergoing surgery with spinal block: The Swiss Beta Blocker in Spinal Anesthesia (BBSA) Study: a double-blinded, placebo-controlled, multicenter trial with l-year follow-up. Anesthesiology 107:33–44

    Article  PubMed  CAS  Google Scholar 

  49. ten Broecke PW, De Hert SG, Mertens E, Adriaensen HF (2003) Effect of preoperative beta-blockade on perioperative mortality in coronary surgery. Br J Anaesth 90:27–31

    Article  PubMed  Google Scholar 

  50. Sear JW, Howell SJ, Sear YM et al (2001) Intercurrent drug therapy and perioperative cardiovascular mortality in elective and urgent/emergency surgical patients. Br J Anaesth 86:506–512

    Article  PubMed  CAS  Google Scholar 

  51. Giles JW, Sear JW, Foex P (2004) Effect of chronic beta-blockade on peri-operative outcome in patients undergoing non-cardiac surgery: an analysis of observational and case control studies. Anaesthesia 59:574–583

    Article  PubMed  CAS  Google Scholar 

  52. Yndgaard S, Lippert FK, Bertheisen PG (1997) Are patients chronically treated with beta 1-adrenoceptor antagonists in fact beta-blocked? J Cardiothor Vascular Anesth 11:32–36

    Article  CAS  Google Scholar 

  53. Tzivoni D, Medina A, David D et al (1998) Effect of metoprolol in reducing myocardial ischemic threshold during exercise and during daily activity. Am J Cardiol 81:775–777

    Article  PubMed  CAS  Google Scholar 

  54. Stone JG, Foex P, Sear JW et al (1988) Risk of myocardial ischaemia during anaesthesia in treated and untreated hypertensive patients. Br J Anaesth 61:675–679

    Article  PubMed  CAS  Google Scholar 

  55. Gottlieb SS, Fisher ML, Kjekshus J et al (2002) Tolerability of beta-blocker initiation and titration in the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF). Circulation 105:1182–1188

    Article  PubMed  CAS  Google Scholar 

  56. Kertai MD, Boersma E, Westerhout CM et al (2004) Association between long-term statin use and mortality after successful abdominal aortic aneurysm surgery. Am J Med 116:96–103

    Article  PubMed  CAS  Google Scholar 

  57. Durazzo AE, Machado FS, Ikeoka DT et al (2004) Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 39:967–975

    Article  PubMed  Google Scholar 

  58. Lindenauer PK, Pekow P, Wang K et al (2004) Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA 291:2092–2099

    Article  PubMed  CAS  Google Scholar 

  59. O’Neil Callahan K, Katsimaglis G, Tepper MR et al (2005) Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J Am Coll Cardiol 45:336–342

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nuffield Department of Anaesthetics, University of Oxford, UK

    G. Howard-Alpe & P. Foëx

Authors
  1. G. Howard-Alpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Foëx
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anaesthesia and Intensive Care Head, Postgraduated School of Anaesthesia and Intensive Care, Catania University Hospital, Catania, Italy

    Antonino Gullo M.D. (Head) (Head)

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Italia

About this paper

Cite this paper

Howard-Alpe, G., Foëx, P. (2008). Perioperative Beta-Blockade: Myths and Realities. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-0773-4_26

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-0773-4_26

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0772-7

  • Online ISBN: 978-88-470-0773-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation