Perioperative b-adrenergic blocking drugs: from concept to applications

  • R. Muchada
Conference paper


Beta blockers (BB) are selective and competitive antagonists of beta adrenergic receptors. They oppose with their action, to the stimulant effect of the sympathoadrenergic system. Since the differentiation of alpha and beta adrenergic receptors by Alhquist [1], pharmacologists have not ceased to create agonist molecules or increasingly selective antagonists. These molecules are designed to produce the desired action with the least possible secondary effect.


Systolic Arterial Pressure Diastolic Heart Failure Beta Blocker Therapy Diastolic Arterial Pressure Negative Inotropic Action 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ahlquist RP (1948) A study of adrenotropic receptors. Am J Physiol 153: 586–600PubMedGoogle Scholar
  2. 2.
    Piriou V, Aouifi A, Lehot JJ (2000) Intérêt des bêta-bloquants en médecine périopératoire. Can J Anaesth 7: 653–663Google Scholar
  3. 3.
    Jones KG, Powell JT (2000) Slowing the heart saves lives: advantages of perioperative ß blockade. Br J Surg 84: 689–690CrossRefGoogle Scholar
  4. 4.
    Roysler RL (2002) Perioperative beta-blockade can reduce morbidity and mortality. APSF Newslett 17: 21–23Google Scholar
  5. 5.
    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: 477–482PubMedGoogle Scholar
  6. 6.
    Coloma M, Chiu JW, White PF, Armbruster SC (2001) The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth Analg 92: 352–357PubMedCrossRefGoogle Scholar
  7. 7.
    Johansen JW, Schneider G, Windsor AM, Sebel PS (1998) Esmolol potentiates reduction of minimum alveolar isoflurane concentration by alfentanil. Anesth Analg 87: 671–676PubMedGoogle Scholar
  8. 8.
    Moniotte S, Kobazik L, Feron O et al (2001) Up regulation of b3 adrenoceptors and altered contractility response to inotropic amines in human failing myocardium. Circulation 103: 1649–1655PubMedGoogle Scholar
  9. 9.
    Zaugg M, Schaub MC, Pasch T, Sphan DR (2002) Modulation of ß adrenergic receptors subtype activities in perioperative medicine: mechanisms and sites of actions. Br J Anaesth 88: 101–123PubMedCrossRefGoogle Scholar
  10. 10.
    Gheorghiade M, Colucci S, Swedelberg K (2003) B Blockers in chronic heart failure. Circulation 107: 1570–1575PubMedCrossRefGoogle Scholar
  11. 11.
    Peterzen B, Lonn U, Babi’c A et al (1999) Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting beta-blocker. J Cardiothorac Vasc Anesth 13: 431–436PubMedCrossRefGoogle Scholar
  12. 12.
    Poldermans D, Boeresma E, Bax JJ et al (1999) The effect of bispropolol 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 341: 1789–1794PubMedCrossRefGoogle Scholar
  13. 13.
    Auerbach AD, Goldamn L (2002) Beta blockers and reduction of cardiac events in non cardiac surgery. JAMA 287: 1435–1444PubMedCrossRefGoogle Scholar
  14. 14.
    Angeja BG, Grossman W (2003) Evaluation and management of diastolic heart failure. Circulation 107: 659–663PubMedCrossRefGoogle Scholar
  15. 15.
    Vasan RS, Benjamin EJ (2001) Diastolic heart failure — no time to relax. N Engl J Med 1: 56–58CrossRefGoogle Scholar
  16. 16.
    Kim MH, Devlin H, Das SK et al (1999) Effect of ß adrenergic blocking therapy on left ventricular diastolic relaxation proprieties in patients with dilated cardiomiopathy. Circulation 100: 729–735PubMedGoogle Scholar
  17. 17.
    Nagatsu M, Spinale FG, Koide M et al (2000) Bradycardia and the role of ß blockade in the amelioration of left ventricle dysfunction. Circulation 101: 653–659PubMedGoogle Scholar
  18. 18.
    Lechat P, Hulot JS, Escolamo S et al (2001) Heart rate and cardiac rhythm relationships with bispropolol benefit in chronic heart failure in CIBIS II trial. Circulation 103: 1428–1433PubMedGoogle Scholar
  19. 19.
    Landesburg G, Zhou W, Aversano T (1999) Tachycardia—induced subendocardial necrosis in acutely instrumented dogs with fixed coronary stenosis. Anesth Analg 88: 973–979PubMedGoogle Scholar
  20. 20.
    Pasternack PF, Imparato AM, Bauman FG et al (1987) The hemodynamics of beta blockade in patient undergoing abdominal aortic aneurysm repair. Circulation 76 (Suppl III): 1–7Google Scholar
  21. 21.
    Fita G, Gomar C, Rovira I (1999) Esmolol en anestesiologfa: farmacologfa e indicaciones. Rev Esp Anestesiol Reanim 46: 404–414PubMedGoogle Scholar
  22. 22.
    Grossman W (2000) Defining diastolic dysfunction. Circulation 101: 2020–2021PubMedGoogle Scholar
  23. 23.
    Banerjee P, Banerjee T, Khand A et al (2002) Diastolic heart failure: neglected or misdiagnosed? J Am Coll Cardiol 39: 138–141PubMedCrossRefGoogle Scholar
  24. 24.
    Zile MR, Brutsaert DL (2002) New concepts in diastolic dysfunction and diastolic heart failure: part I. Circulation 105: 1387–1393PubMedCrossRefGoogle Scholar
  25. 25.
    Zile MR, Brutsaert DL (2002) New concepts in diastolic dysfunction and diastolic heart failure: part II. Circulation 105: 1503–1508PubMedCrossRefGoogle Scholar
  26. 26.
    Bristow MR (1997) Mechanism of action of beta-blocking agents in heart failure. Am J Cardiol 80: 26L - 40LPubMedCrossRefGoogle Scholar
  27. 27.
    Krum H (1999) ß blockers in heart failure. The “new wave” of clinical trials. Drugs 58: 203–210PubMedCrossRefGoogle Scholar
  28. 28.
    Muchada R (2002) Cardio beta modulation with dobutamine — esmolol simultaneous perfusion. Anesthesiology 96: A635Google Scholar
  29. 29.
    Muchada R (1999) Non invasive hemodynamic diagnostic of hyperkinetic septic shock treated with 13 blocker. Intensive Care Med 25 Suppl 1: 142Google Scholar
  30. 30.
    Shakar SF, Abrham WT, Gilbert EM et al (1998) Combined oral positive inotropic and 13 blockers therapy for treatment of refractory class VI heart failure. J Am Coll Cardiol 31: 1336–1340PubMedCrossRefGoogle Scholar
  31. 31.
    Bristow MR, Shakar SF, Linseman JV et al (2001) Inotropes and 13—blockers: is there a need for new guidelines? J Cardiac Failure 72 (Suppl 1): 8–12CrossRefGoogle Scholar
  32. 32.
    Bristow M (2003) Antiadrenergic therapy of chronic heart failure. Surprises and new opportunities. Circulation 107: 1100–1102PubMedCrossRefGoogle Scholar
  33. 33.
    Magnano DT, Layug EL, Wallace A et al (1996) Effect of atenolol on mortality and morbidity after non cardiac surgery. Multicenter study of perioperative research group. N Engl J Med 335: 1713–1720CrossRefGoogle Scholar
  34. 34.
    Harwood TN, Butterworth J, Prielipp RC et al (1999) The safety and the effectiveness of esmolol in the perioperative period in patients undergoing abdominal aortic surgery. J Cardiothorac Vasc Anesth 13: 555–561PubMedCrossRefGoogle Scholar
  35. 35.
    Frishman WH, Cheng A (1999) Secondary prevention of myocardial infarction: role of beta adrenergic blockers and angiotensin converting enzyme inhibitors. Am Heart J 137: S25 - S34PubMedCrossRefGoogle Scholar
  36. 36.
    Palatini P, Casaglia E, Julius S, Pessina AC (1999) High heart rate: a risk factor for cardiovascular death in elderly men. Arch Intern Med 159: 585–592PubMedCrossRefGoogle Scholar
  37. 37.
    Barbier GH, Shettigar UR, Appunn DO (1995) Clinical rationale for the use of an ultra short acting beta-blocker; esmolol. Int J Clin Pharmacol Ther 33: 212–218PubMedGoogle Scholar
  38. 38.
    Leug JM, Manku K (2000) Prophylactic therapy of preoperative myocardial ischemia. Curr Anesthesiol Rep 2: 77–85Google Scholar
  39. 39.
    Howell SJ, Sear JW, Foex P (2001) Peri-operative 13-blockade a useful treatment that should be greeted with cautious enthusiasm. Br J Anaesth 2: 161–164CrossRefGoogle Scholar
  40. 40.
    Kleiman B (2002) Perioperative beta-blockade requires further study — not standard of care. APSF Newslett 17: 55Google Scholar
  41. 41.
    Manigaux C, Guignard B, Adam F et al (2002) Esmolol prevent movement and attenuates BIS response to orotracheal intubation. Br J Anaesth 89: 857–862CrossRefGoogle Scholar
  42. 42.
    Than PH, Yang LC, Shih HC et al (2002) Combined use of esmolol and nicardipine to blunt the haemodynamic changes following laryngoscopy and tracheal intubation. Anaesthesia 57: 1195–1212CrossRefGoogle Scholar
  43. 43.
    Scott DB, Buckley FP, Drumond GB et al (1978) Cardiovascular effect of labetalol during halothane anaesthesia. Br J Anaesth 3 (Suppl): 817–821Google Scholar
  44. 44.
    Edmonson R, Del Valle O, Sha N et al (1989) Esmolol for potation of nitroprusside-induced hypotension: impact on the cardiovascular adrenergic and rening angiotensin systems in men. Anesth Analg 69: 202–206Google Scholar
  45. 45.
    Gold MI, Sacks DJ, Grosnoff DB et al (1989) Use of esmolol during anesthesia to treat tachycardia and hypertension. Anesth Analg 68: 104–104CrossRefGoogle Scholar
  46. 46.
    Seltzer JL, Ritter DE, Starsnic MA, Man AT (1985) The hemodynamic response to traction on the abdominal mesentery. Anesthesiology 63: 96–99PubMedCrossRefGoogle Scholar
  47. 47.
    Muchada R (2001) Mesure du débit aortique par méthode non invasive. In: Dalens B (ed) Traité d’anesthésie générale, vol 4. Arnette, Rueil-Malmaison, pp 2–18Google Scholar
  48. 48.
    Peterson GE, Brickner E, Reimold SC (2003) Transesophageal echocardiography. Clinical indications and applications. Circulation 107: 2398–2402PubMedCrossRefGoogle Scholar
  49. 49.
    Askenazi J, MacCosbe PE, Hoff J et al (1987) Hemodynamic effects of esmolol, an ultrashortacting beta blocker. J Clin Pharmacol 27: 567–573PubMedGoogle Scholar
  50. 50.
    Buffington CW (1985) Hemodynamic determinants of ischemia myocardial disfunction. Aneshtesiology 63: 655–662Google Scholar
  51. 51.
    Menkaus PG, Reyes JG, Kissing Yet al (1985) Cardiovascular effects of esmolol in anesthetized humans. Anesth Analg 64: 327–334Google Scholar
  52. 52.
    Reilly CS, Wood M, Kosakii RP, Wood AJ (1985) Ultra-short-acting-blockade: a comparison with conventional beta-blockade. Clin Pharmacol Ther 38: 579–585PubMedCrossRefGoogle Scholar
  53. 53.
    Sasao J, Tarver SD, Kindscher JM et al (2001) In rabbits, landiolol, a new ultra-short-acting ß-blocker exert more potent negative chronotropic effect and less effect on blood pressure than esmolol. Can J Anaesth 48: 985–989PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2004

Authors and Affiliations

  • R. Muchada

There are no affiliations available

Personalised recommendations