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Anesth Analg 1983; 62:380-390
© 1983 International Anesthesia Research Society
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Long-Term Metoprolol Therapy and Neuroleptanesthesia in Coronary Artery Surgery

Withdrawal versus Maintenance ß1–Adrenoreceptor Blockade

Johan Pontán, MD, Jan Häggendal, MD, Italo Milocco, MD, and Anders Waldenström, MD

Departments of Anesthesiology, Cardiology, and Pharmacology, University of Göteborg, Sweden.

Abstract

Patients receiving metoprolol before cardiac revascularization surgery were randomly divided into those in whom metoprolol was discontinued before the operation (N = 10) and those in whom metoprolol was continued up to the time of operation (N = 10). Cardiovascular responses to neuroleptanesthesia and sternotomy were studied. Coronary sinus catheterization for blood-flow measurement and sampling was performed in 5 patients in each group. Two of 10 patients had a myocardial infarction after discontinuation of metoprolol and surgery was therefore postponed. Tachycardias were common during intubation after discontinuation of metoprolol, but otherwise hemodynamic responses and myocardial oxygen consumption were similar in both groups. Recurrent ST-T depression occurred in 7 of 8 patients and myocardial lactate release in 2 of 5 patients in whom metoprolol was withdrawn, whereas patients who continued to receive metoprolol showed few episodes of ST-T depression (2 of 10) and no lactate release. The latter had lower plasma norepinephrine (NE) levels, but myocardial release of NE was similar in both groups. Preoperative metoprolol withdrawal seemed to precipitate myocardial ischemia, whereas maintenance of therapy was well tolerated.

Key Words: SYMPATHETIC NERVOUS SYSTEM • Sympatholytic Agents • metoprolol • HEART • metoprolol • ANESTHESIA • cardiovascular




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1983 by the International Anesthesia Research Society.