Beta blockers in premedication of the cardiac patient — a must in 2003?!

  • M. Klimek
Conference paper


Myocardial cardiac events are the most common medical complication of surgery, occurring in 2–5% of patients undergoing noncardiac surgery and as many as 30% of patients undergoing vascular surgery. Perioperative cardiac events are associated with a mortality rate of nearly 60% per event, prolonged hospitalisation, and high costs [1, 2]. One study found that postoperative ischaemia increased the odds of postoperative myocardial events 21-fold [3].


Beta Blocker Noncardiac Surgery Abdominal Aortic Aneurysm Repair Silent Myocardial Ischaemia Beta Blockade 


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  1. 1.
    Mangano DT, Wong MG, London MJ et al (1991) Perioperative myocardial ischemia in patients undergoing noncardiac surgery. I. Incidence and severity during the 1st week after surgery. The Study of Perioperative Ischemia ( SPI) Research Group. J Am Coll Cardiol 17: 851–857PubMedCrossRefGoogle Scholar
  2. 2.
    Mangano DT, Browner WS, Hollenberg M et al (1990) Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med 323: 1781–1788PubMedCrossRefGoogle Scholar
  3. 3.
    Landesberg G, Luria MH, Cotev S et al (1993) Importance of long-duration postoperative ST segment depression in cardiac morbidity after vascular surgery. Lancet 341: 715–719PubMedCrossRefGoogle Scholar
  4. 4.
    Warltier DC (1998) Beta-adrenergic-blocking drugs: incredibly useful, incredibly underutilized. Anesthesiology 88: 2–5PubMedCrossRefGoogle Scholar
  5. 5.
    Prys-Roberts C, Foex P, Biro GP et al (1973) Studies of anaesthesia in relation to hypertension. V. Adrenergic beta-receptor blockade. Br J Anaesth 45: 671–681CrossRefGoogle Scholar
  6. 6.
    Smulyan H, Weinberg SE, Howanitz PJ (1982) Continuous propranolol infusion following abdominal surgery. JAMA 247: 2539–2542PubMedCrossRefGoogle Scholar
  7. 7.
    Slogoff S, Keats AS (1986) Further observations on perioperative myocardial ischemia. Anesthesiology 65: 539–542PubMedCrossRefGoogle Scholar
  8. 8.
    Slogoff S, Keats AS (1985) Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 62: 107–114PubMedCrossRefGoogle Scholar
  9. 9.
    Atkinson RS, Rushman GB, Lee JA (1987) A synopsis of anaesthesia, 10th edn. Wright, BristolGoogle Scholar
  10. 10.
    Zaugg M, Jamali NZ, Lucchinetti E et al (2000) Norepinephrine-induced apoptosis is inhibited in adult rat ventricular myocytes exposed to volatile anesthetics. Anesthesiology 93: 209–218PubMedCrossRefGoogle Scholar
  11. 11.
    Pasternack PF, Imparato AM, Baumann FG et al (1987) The hemodynamics of beta-blockade in patients undergoing abdominal aortic aneurysm repair. Circulation 76: 1111–1117Google Scholar
  12. 12.
    Cruickshank JM, Neil-Dwyer G, Degaute JP et al (1987) Reduction of stress/catecholamine-induced cardiac necrosis by beta 1- selective blockade. Lancet 1I: 585–589CrossRefGoogle Scholar
  13. 13.
    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: 495–500PubMedCrossRefGoogle Scholar
  14. 14.
    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: 869–872PubMedCrossRefGoogle Scholar
  15. 15.
    Mangano DT, Layug EL, Wallace A et al (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335: 1713–1720CrossRefGoogle Scholar
  16. 16.
    Wallace A, Layug B, Tateo I et al (1998) Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 88: 7–17PubMedCrossRefGoogle Scholar
  17. 17.
    Mangano DT (1997) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med 1997; 336: 1453–1454Google Scholar
  18. 18.
    American College of Physicians (1997) Clinical guideline I. Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. Ann Intern Med 127: 309–312Google Scholar
  19. 19.
    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. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 341: 1789–1794PubMedCrossRefGoogle Scholar
  20. 20.
    Boersma E, Poldermans D, Bax JJ et al (2001) Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 285: 1865–1873CrossRefGoogle Scholar
  21. 21.
    Raby KE, Brull SJ, Timimi Fetal (1999) The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg 88: 477–482PubMedGoogle Scholar
  22. 22.
    Urban MK, Markowitz SM, Gordon MA et al (2000) Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg 90: 1257–1261PubMedCrossRefGoogle Scholar
  23. 23.
    Zaugg M, Tagliente T, Lucchinetti E et al (1999) Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery. Anesthesiology 91: 1674–1686PubMedCrossRefGoogle Scholar
  24. 24.
    Howell SJ, Sear JW, Foëx P (2001) Perioperative 3-blockade: a useful treatment that should be greeted with cautious enthousiasm. Br J Anaesth 86: 161–164PubMedCrossRefGoogle Scholar
  25. 25.
    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: 506–512PubMedCrossRefGoogle Scholar
  26. 26.
    Sear JW, Foex P, Howell SJ (2000) Effect of chronic intercurrent medication with beta-adrenoceptor blockade or calcium channel entry blockade on postoperative silent myocardial ischaemia. Br J Anaesth 84: 311–315PubMedCrossRefGoogle Scholar
  27. 27.
    Higham HE, Sear JW, Sear YM et al (2000) Does perioperative silent myocardial ischaemia predict long-term adverse outcome in surgical patients. Br J Anaesth 85: 651P–652 PGoogle Scholar
  28. 28.
    Howell SJ, Sear YM, Yeates D et al (1999) [3-B lockersand perioperative cardiovascular risk. Br J Anaesth 82: 458 PCrossRefGoogle Scholar
  29. 29.
    Sear JW, George S, Sear YM et al (1999) Can we predict the development of postoperative cardiovascular complications in non-cardiac surgical patients? Br J Anaesth 82 Suppl I: 4Google Scholar
  30. 30.
    Sutton T, Rock P (1999) Pro: beta-blockers should be used in all patients undergoing vascular surgery. J Cardiothorac Vasc Anesth 13: 490–495PubMedCrossRefGoogle Scholar
  31. 31.
    Böttiger BW, Martin E (2000) Prevention of perioperative myocardial ischemia–an update. Anaesthesist 49: 174–186PubMedCrossRefGoogle Scholar
  32. 32.
    Piriou V, Aouifi A, Lehot JJ (2000) Perioperative beta-blockers. 2. Therapeutic indications. Can J Anaesth 47: 664–672Google Scholar
  33. 33.
    Jones KG, Powell JT (2000) Slowing the heart saves lives: advantages of perioperative beta-blockade. Br J Surg 87: 689–690PubMedCrossRefGoogle Scholar
  34. 34.
    Selzman CH, Miller SA, Zimmerman MA et al (2001) The case for beta-adrenergic blockade as prophylaxis against perioperative cardiovascular morbidity and mortality. Arch Surg 136: 286–290PubMedCrossRefGoogle Scholar
  35. 35.
    Lee TH (1999) Reducing cardiac risk in noncardiac surgery. N Engl J Med 341: 1838–1840PubMedCrossRefGoogle Scholar
  36. 36.
    Damen J (2001) Perioperatieve myocardischemie en niet-cardiale chirurgie. III. Preventie van myocardischemie en cardiale complicaties: een conceptrichtlijn. NVIC Monitor, 2001: 4–18Google Scholar
  37. 37.
    Ten Broecke PWC, de Hert SG, Mertens E et al (2003) Effect of preoperative beta-blockade on perioperative mortality in coronary surgery. Br J Anesth 90: 27–31CrossRefGoogle Scholar
  38. 38.
    Rabbani R, Topol EJ (1999) Strategies to achieve coronary arterial plaque stabilization. Cardiovasc Res 41: 402–417PubMedCrossRefGoogle Scholar
  39. 39.
    Piriou V, Aouifi A, Lehot JJ (2000) Perioperative beta-blockers. 1. Fundamentals. Can J Anaesth 47: 653–663Google Scholar
  40. 40.
    Guvendik L, Davies M, Parker DJ (1986) Oral beta-blockade with hypothermic potassium cardioplegia in cardiac surgery. Is there an additive protective effect? Thorac Cardiovasc Surg 34: 25–29PubMedCrossRefGoogle Scholar
  41. 41.
    CIBIS II Investigators and Committees (1999) The cardiac insufficiency bisoprolol study. H. (CIBIS-II): a randomised trial. Lancet 353: 9–13CrossRefGoogle Scholar
  42. 42.
    Bühler, FR, Bolli P (1980) The concept of beta-adrenoreceptor blockade in the primary and secondary prevention of cardiac mortality and morbidity. Triangle 19: 35–45PubMedGoogle Scholar
  43. 43.
    Szabo BM, De Graeff PA (2000) Beta-blockers bij hartfalen. Geneesmiddelbulletin 34: 65–70Google Scholar
  44. 44.
    Yndgaard S, Lippert FK, Berthelsen PG (1997) Are patients chronically treated with beta 1-adrenoceptor antagonists in fact beta-blocked? J Cardiothorac Vasc Anesth 11: 32–36PubMedCrossRefGoogle Scholar
  45. 45.
    Milligan G, MacEwan DJ, Mercouris M et al (1997) Inverse agonism at adrenergic and opioid receptors: studies with wild type and constitutively active mutant receptors. Receptors Channels 5: 209–213PubMedGoogle Scholar
  46. 46.
    Gottlieb S (2001) (3-Blocker response may have gene link. BMJ 322: 814CrossRefGoogle Scholar
  47. 47.
    Hansson L, Zanchetti A, Carruthers SG et al (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351: 1755–1762PubMedCrossRefGoogle Scholar
  48. 48.
    Tafreshi MJ, Weinacker AB (1999) Beta-adrenergic-blocking agents in bronchospastic diseases: a therapeutic dilemma. Pharmacotherapy 19: 974–978PubMedCrossRefGoogle Scholar
  49. 49.
    Bristow MR (2000) Beta-adrenergic receptor blockade in chronic heart failure. Circulation 101: 558–569PubMedGoogle Scholar
  50. 50.
    Abraham WT (2000) Beta-blockers: the new standard of therapy for mild heart failure. Arch Intern Med 160: 1237–1247PubMedCrossRefGoogle Scholar
  51. 51.
    Hjalmarson A, Goldstein S, Fagerberg B et al (2000) Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group. JAMA 283: 1295–1302PubMedCrossRefGoogle Scholar
  52. 52.
    Bonet S, Agusti A, Arnau JM et al (2000) Beta-adrenergic blocking agents in heart failure: benefits of vasodilating and non-vasodilating agents according to patients’ characteristics: meta-analysis of clinical trials. Arch Intern Med 160: 621–627PubMedCrossRefGoogle Scholar
  53. 53.
    Böttiger BW, Martin E (2001) Beta-Rezeptorenblocker verbessern postoperatives Überleben koronarer Risikopatienten. Dtsch Arzteblatt 198:A 1896–1898Google Scholar
  54. 54.
    Park KW (2003) Preoperative cardiology consultation. Anesthesiology 98: 754–762PubMedCrossRefGoogle Scholar
  55. 55.
    Auerbach AD, Goldman L (2002) Beta-Blockers and reduction of cardiac events in noncardiac surgery (scientific review). JAMA 287: 1435–1444PubMedCrossRefGoogle Scholar
  56. 56.
    Shammash JB, Trost JC, Gold JM et al (2001) Perioperative beta-blocker withdrawal and mortality in vascular surgical patients. Am Heart J 141: 148–153PubMedCrossRefGoogle Scholar
  57. 57.
    Martinez EA, Kim LJ, Faraday N et al (2000) Postoperative use of beta-blockers reduces mortality at one year in high risk surgical patients. ASA Abs: A-238Google Scholar
  58. 58.
    Fonarow GC, Gawlinski A, Moughrabi S et al (2001) Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program ( CHAMP ). Am J Cardiol 87: 819–822PubMedCrossRefGoogle Scholar
  59. 59.
    Armanious S, Wong DT, Etchells E et al (2003) Successful implementation of perioperative beta-blockade utilizing a multidisciplinary approach. Can J Anaesth 50: 131–136PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia, Milano 2004

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  • M. Klimek

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