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ANESTHETIC PHARMACOLOGY

Atenolol Administration via a Nasogastric Tube After Abdominal Surgery: An Unreliable Route

Marilyn Gosgnach, MD^*, Guy Aymard, PharmD, Catherine Huraux, MD^*, Marie Hélène Fléron, MD^*, Pierre Coriat, MD^*, and Bertrand Diquet, PhD

Departments of *Anesthesiology and Pharmacology, Hospital Pitié-Salpêtrière, Paris, France

Address correspondence and reprint requests to Pierre Coriat, MD, Département d’Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l’Hôpital, 75 561 Paris Cedex 13, France. Address e-mail to pierre.coriat{at}psl.ap-hop-paris.fr

ß-Adrenoceptor antagonists, especially atenolol, reduce perioperative cardiac morbidity. Because there are no data on the bioavailability of atenolol given by nasogastric tube in the postoperative period, we assessed the efficacy of this route of administration in 18 patients scheduled for abdominal surgery. We found a 36% reduction in the area under the atenolol concentration curve and a 46% reduction in the peak concentration of atenolol in the postoperative period compared with preoperative values. In addition, patients had more rapid mean heart rates on the second postoperative day compared with the day before surgery. We conclude that the administration of atenolol via nasogastric tube in the postoperative period does not result in adequate plasma concentrations.

IMPLICATIONS: Atenolol administered at the same preoperative dose via a nasogastric tube after abdominal surgery leads to reduced bioavailability due to decreased absorption. The beneficial effects of perioperative IV atenolol cannot be expected from this route of administration.