JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow En Espanol
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (80)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Urban, M. K.
Right arrow Articles by Kligfield, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Urban, M. K.
Right arrow Articles by Kligfield, P.
Anesth Analg 2000;90:1257-1261
© 2000 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIA

Postoperative Prophylactic Administration of ß-Adrenergic Blockers in Patients at Risk for Myocardial Ischemia

Michael K. Urban, MD, PhD*, Steven M. Markowitz, MD{dagger}, Michael A. Gordon, MD*, Barbara L. Urquhart, RN*, and Paul Kligfield, MD{dagger}

*Department of Anesthesiology, Hospital for Special Surgery—Weill Medical College of Cornell University; and {dagger}Department of Cardiology, New York Hospital—Weill Medical College of Cornell University, New York, New York

Address correspondence and reprint requests to Michael Urban, MD, PhD, Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021.

Perioperative myocardial ischemia (MI) is associated with postoperative cardiac morbidity. Postoperative sympatholysis may reduce the incidence of MI. This study evaluated such a reduction postoperatively with the administration of prophylactic ß-blockers in patients undergoing elective total knee arthroplasty with epidural anesthesia and postoperative epidural analgesia. One hundred seven patients were preoperatively randomized into two groups, control and ß-blockers, who received postoperative esmolol infusions on the day of surgery and metoprolol for the next 48 h to maintain a heart rate less than 80 bpm. Patients were followed for ST segment depression by using a Holter monitor and adverse cardiac outcomes. Postoperative electrocardiographic ischemia was significantly more prevalent in the control group compared with the ß-blocker group during esmolol blockade (0 of 52 vs 4 of 55; P = 0.04) and tended to be more common in the control group the next two days (8 of 55 vs 3 of 52; P = 0.135). In addition, the number of ischemic events (control, 50; ß-blockers, 16) and total ischemic time (control, 709 min; ß-blocker, 236 min) were also significantly different from the control group. Myocardial infarctions and cardiac events were more common in the control group, but these differences were not significant. Our results suggest that the use of prophylactic ß-blocker therapy may reduce the incidence of postoperative MI.

Implications: Prophylactic ß adrenergic blockade administered after elective total knee arthroplasty was associated with a reduced prevalence and duration of postoperative myocardial ischemia detected with Holter monitoring.




This article has been cited by other articles:


Home page
 J CARDIOVASC PHARMACOL THERHome page
D. Domanski and E. R. Schwarz
Clinical Review: Is the Perioperative Use of {beta}-Blockers Still Recommended? A Critical Review of Recent Controversies
Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2009; 14(4): 258 - 268.
[Abstract] [PDF]

Home page
 J Am Coll CardiolHome page
American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, L. A. Fleisher, et al.
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
J. Am. Coll. Cardiol., November 24, 2009; 54(22): e13 - e118.
[Full Text] [PDF]

Home page
 CirculationHome page
2007 WRITING COMMITTEE MEMBERS, L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, et al.
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation, November 24, 2009; 120(21): e169 - e276.
[Full Text] [PDF]

Home page
 Cleveland Clinic Journal of MedicineHome page
D. POLDERMANS and P. J. DEVEREAUX
The experts debate: Perioperative beta-blockade for noncardiac surgery--proven safe or not?
Cleveland Clinic Journal of Medicine, November 1, 2009; 76(Suppl_4): S84 - S92.
[Abstract] [Full Text] [PDF]

Home page
 The Annals of PharmacotherapyHome page
R. Talati, K. M Reinhart, C M. White, O. J Phung, A. Sedrakyan, J. Kluger, and C. I Coleman
Outcomes of Perioperative {beta}-Blockade in Patients Undergoing Noncardiac Surgery: A Meta-Analysis
Ann. Pharmacother., July 1, 2009; 43(7): 1181 - 1188.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
J. W. Sear, J. W. Giles, G. Howard-Alpe, and P. Foex
Perioperative beta-blockade, 2008: What does POISE tell us, and was our earlier caution justified?
Br. J. Anaesth., August 1, 2008; 101(2): 135 - 138.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. J. London
Quo Vadis, Perioperative Beta Blockade? Are You "POISE'd" on the Brink?
Anesth. Analg., April 1, 2008; 106(4): 1025 - 1030.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
W. S. Beattie, D. N. Wijeysundera, K. Karkouti, S. McCluskey, and G. Tait
Does Tight Heart Rate Control Improve Beta-Blocker Efficacy? An Updated Analysis of the Noncardiac Surgical Randomized Trials
Anesth. Analg., April 1, 2008; 106(4): 1039 - 1048.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
B. M. Biccard, J. W. Sear, and P. Foex
Meta-analysis of the effect of heart rate achieved by perioperative beta-adrenergic blockade on cardiovascular outcomes
Br. J. Anaesth., January 1, 2008; 100(1): 23 - 28.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242.
[Full Text] [PDF]

Home page
 CirculationHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Circulation, October 23, 2007; 116(17): e418 - e500.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-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., January 1, 2007; 104(1): 15 - 26.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
F. Wiesbauer, O. Schlager, H. Domanovits, B. Wildner, G. Maurer, M. Muellner, H. Blessberger, and M. Schillinger
Perioperative {beta}-Blockers for Preventing Surgery-Related Mortality and Morbidity: A Systematic Review and Meta-Analysis
Anesth. Analg., January 1, 2007; 104(1): 27 - 41.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
A. O. Adesanya, J. A. de Lemos, N. B. Greilich, and C. W. Whitten
Management of perioperative myocardial infarction in noncardiac surgical patients.
Chest, August 1, 2006; 130(2): 584 - 596.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta-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) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Medicine and Biology
J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2343 - 2355.
[Full Text] [PDF]

Home page
 BMJHome page
P J Devereaux, W S. Beattie, P. T-L Choi, N. H Badner, G. H Guyatt, J. C Villar, C. S Cina, K. Leslie, M. J Jacka, V. M Montori, 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
BMJ, August 6, 2005; 331(7512): 313 - 321.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
H.-J. Priebe
Perioperative myocardial infarction--aetiology and prevention
Br. J. Anaesth., July 1, 2005; 95(1): 3 - 19.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. Boldt, C. Brosch, A. Lehmann, S. Suttner, and F. Isgro
The Prophylactic Use of the {beta}-Blocker Esmolol in Combination with Phosphodiesterase III Inhibitor Enoximone in Elderly Cardiac Surgery Patients
Anesth. Analg., October 1, 2004; 99(4): 1009 - 1017.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. Zaugg, C. Schulz, J. Wacker, and M. C. Schaub
Sympatho-modulatory therapies in perioperative medicine
Br. J. Anaesth., July 1, 2004; 93(1): 53 - 62.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
P. K. Lindenauer, J. Fitzgerald, N. Hoople, and E. M. Benjamin
The Potential Preventability of Postoperative Myocardial Infarction: Underuse of Perioperative {beta}-Adrenergic Blockade
Arch Intern Med, April 12, 2004; 164(7): 762 - 766.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
M. D. Kertai, E. Boersma, J. J. Bax, I. R. Thomson, M. J. Cramer, L. L. M. van de Ven, M. G. Scheffer, G. Trocino, C. Vigna, H. F. Baars, et al.
Optimizing Long-term Cardiac Management After Major Vascular Surgery: Role of {beta}-Blocker Therapy, Clinical Characteristics, and Dobutamine Stress Echocardiography to Optimize Long-term Cardiac Management After Major Vascular Surgery
Arch Intern Med, October 13, 2003; 163(18): 2230 - 2235.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
R. D. Stevens, H. Burri, and M. R. Tramer
Pharmacologic Myocardial Protection in Patients Undergoing Noncardiac Surgery: A Quantitative Systematic Review
Anesth. Analg., September 1, 2003; 97(3): 623 - 633.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
M. Licker, G. Khatchatourian, A. Schweizer, M. Bednarkiewicz, D. Tassaux, and C. Chevalley
The Impact of a Cardioprotective Protocol on the Incidence of Cardiac Complications After Aortic Abdominal Surgery
Anesth. Analg., December 1, 2002; 95(6): 1525 - 1533.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
A. D. Auerbach and L. Goldman
{beta}-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Scientific Review
JAMA, March 20, 2002; 287(11): 1435 - 1444.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
A. D. Auerbach and L. Goldman
{beta}-Blockers and Reduction of Cardiac Events in Noncardiac Surgery: Clinical Applications
JAMA, March 20, 2002; 287(11): 1445 - 1447.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. Zaugg, M. C. Schaub, T. Pasch, and D. R. Spahn
Modulation of {beta}-adrenergic receptor subtype activities in perioperative medicine: mechanisms and sites of action
Br. J. Anaesth., January 1, 2002; 88(1): 101 - 123.
[Abstract] [Full Text] [PDF]

Home page
 SEMIN CARDIOTHORAC VASC ANESTHHome page
D. A. Zvara
Treatment of Perioperative Myocardial Ischemia
Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 2001; 5(2): 166 - 183.
[Abstract] [PDF]

Home page
 Arch SurgHome page
C. H. Selzman, S. A. Miller, M. A. Zimmerman, and A. H. Harken
The Case for {beta}-Adrenergic Blockade as Prophylaxis Against Perioperative Cardiovascular Morbidity and Mortality
Arch Surg, March 1, 2001; 136(3): 286 - 290.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
S. J. Howell, J. W. Sear, and P. Foex
Editorial I: Peri-operative {beta}-blockade: a useful treatment that should be greeted with cautious enthusiasm
Br. J. Anaesth., January 1, 2001; 86(2): 161 - 164.
[Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2000 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2000 by the International Anesthesia Research Society.