Anest. intenziv. Med. 2007;18(5):296-300

Do beta-blockers still have their role in myocardial protection?Anaesthesiology - Review articles

M. Horáček
Klinika anesteziologie a resuscitace, FN v Motole a IPVZ, Praha

Cardiovascular complications after non-cardiac surgery occur in one out of ten patients. All possible risk-reducing approaches including perioperative beta-blockade are warranted. Beta-blocker administration is based on the results of randomized controlled studies performed by Mangano et al. and Poldermans et al. However, new findings cast doubt on routine beta-blocker use. Current recommendations for perioperative beta-blockade for non-cardiac surgery are presented in this review.

Keywords: non-cardiac surgery; perioperative period; beta-blockade

Published: October 1, 2007  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Horáček M. Do beta-blockers still have their role in myocardial protection? Anest. intenziv. Med. 2007;18(5):296-300.
Download citation

References

  1. Khuri, S. F. et al. The Department of Veterans Affairs' NSQIP: The first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann. Surg., 1998, 228, 4, p. 491-507. Go to original source... Go to PubMed...
  2. Safe Practices for Better Healthcare: A Consensus Report. Summary. The National Quality Forum. August 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nqfpract.htm (poslední přístup 17.8.2007).
  3. Mangano, D. T. et al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N. Engl. J. Med., 1996, 335, 23, p. 1713-1720. Go to original source... Go to PubMed...
  4. Poldermans, D. et al. 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, p. 1789-1794. Go to original source... Go to PubMed...
  5. Lindenauer, K. et al. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N. Engl. J. Med., 2005, 353, 4, p. 349-361. Go to original source... Go to PubMed...
  6. Biccard, B. M. et al. Acute peri-operative beta blockade in intermediate-risk patients. Anaesthesia, 2006, 61, 10, p. 924-931. Go to original source... Go to PubMed...
  7. Wiysonge, C. S. et al. Beta-blockers for hypertension. Cochrane Database Syst. Rev., 2007 Jan 24, 1, CD002003. Go to original source... Go to PubMed...
  8. Williams, B. et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation, 2006, 113, 9, p. 1213-1225. Go to original source...
  9. Freemantle, N. et al. Beta-blockade after myocardial infarction: systematic review and metaregression analysis. BMJ, 1999, 318, 7200, p. 1730-1737. Go to original source... Go to PubMed...
  10. Lechat, P. et al. Clinical effects of β-adrenergic blockade in chronic heart failure: a meta-analysis of randomised clinical trials. Circulation, 1998, 98, 12, p. 1184-1191. Go to original source... Go to PubMed...
  11. Adesanya, A. O. et al. Management of perioperative myocardial infarction in noncardiac surgical patients. Chest, 2006, 130, 2, p. 584-596. Go to original source... Go to PubMed...
  12. Eagle, K. A. et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery - Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Non-cardiac Surgery). Anesth. Analg., 2002, 94, 5, p. 1052-1064. Go to PubMed...
  13. Fleisher, L. A. et al. ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative ß-blocker therapy. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth. Analg., 2007, 104, 1, p. 15-26. Go to original source... Go to PubMed...
  14. Yang, H. et al. The effects of perioperative ß-blockade: Results of the Metoprolol After Vascular Surgery (MAVS) study, a randomized controlled trial. Am. Heart J., 2006, 152, 5, p. 983-990. Go to original source... Go to PubMed...
  15. Juul, A. B. et al. Effect of perioperative beta-blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. Brit. Med. J., 2006, 332, 7556, p. 1482-1488. Go to original source... Go to PubMed...
  16. Brady, A. R. et al. Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blinded controlled trial. J. Vasc. Surg., 2005, 41, 4, p. 602-609. Go to original source... Go to PubMed...
  17. Auerbach, A. D., Goldman, L. Beta-blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA, 2002, 287, 11, p. 1435-1444. Go to original source... Go to PubMed...
  18. Auerbach, A. D., Goldman, L. Beta-blockers and reduction of cardiac events in noncardiac surgery: clinical applications. JAMA, 2002, 287, 11, p. 1445-1447. Go to original source... Go to PubMed...
  19. Stevens, R. D. et al. Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth. Analg., 2003, 97, 3, p. 623-633. Go to original source... Go to PubMed...
  20. McGory, M. L. et al. A meta-analysis of perioperative beta blockade: what is the actual risk reduction? Surgery, 2005, 138, 2, p. 171-179. Go to original source... Go to PubMed...
  21. Schouten, O. et al. A meta-analysis of safety and effectiveness of perioperative beta-blocker use for the prevention of cardiac events in different types of noncardiac surgery. Coron. Artery Dis., 2006, 17, 2, p. 173-179. Go to original source... Go to PubMed...
  22. Devereaux, P. J. et al. 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. Brit. Med. J., 2005, 331, 7512, p. 313-321. Go to original source... Go to PubMed...
  23. Bultas, J. Farmakogenetika, účinek léku a lékové interakce. Remedia, 2005, 15, 2, s.115-119. Go to original source...
  24. Raby, K. E. et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth. Analg., 1999, 88, 3, p. 477-482. Go to original source... Go to PubMed...
  25. Poldermans, D. et al. 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, p. 964-969. Go to original source... Go to PubMed...
  26. Feringa, H. H. et al. High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients. Circulation, 2006, 114, Suppl. 1, p. 1344-1349. Go to original source... Go to PubMed...
  27. Zaugg, M. et al. 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 1-year follow up. Anesthesiology, 2007, 107, 1, p. 33-44. Go to original source... Go to PubMed...
  28. Giles, J. W. et al. Effect of chronic beta-blockade on peri-operative outcome in patients undergoing non-cardiac surgery: an analysis of observational and case control studies. Anaesthesia, 2004, 59, 6, p. 574-583. Go to original source... Go to PubMed...
  29. London, M. J. et al. Perioperative beta-adrenergic receptor blockade: physiologic foundations and clinical controversies. Anesthesiology, 2004, 100, 1, p. 170-175. Go to original source... Go to PubMed...
  30. Fleisher, L. A. Perioperative ß-blockade: How best to translate evidence into practice. Anaesth. Analg., 2007, 104, 1, p. 1-3. Go to original source... Go to PubMed...
  31. Bolsin, S. et al. ß-blockers and statins in non-cardiac surgery. Brit. J. Med., 2007, 334, 7607, p. 1283-1284. Go to original source... Go to PubMed...
  32. Redelmeier, D. et al. Beta-blockers for elective surgery in elderly patients: population based, retrospective cohort study. Brit. J. Med., 2005, 331, 7522, p. 932. Go to original source... Go to PubMed...
  33. Hackam, D. G. Perioperative ß-blocker therapy in vascular surgery: Clinical update. J. Vasc. Surg., 2006, 43, 3, p. 632-634. Go to original source... Go to PubMed...




Anesteziologie a intenzivní medicína

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.