Martos BFD, Alonso RL, Linares RAL, Soto GA, Alonso RR, García ML

Idioma: Español
Referencias bibliográficas: 47
Paginas: 31-53
Archivo PDF: 596.28 Kb.

RESUMEN

Introducción: los eventos cardiacos perioperatorios son desórdenes frecuentes y asociados a un incremento de la mortalidad. Los β-bloqueadores se han utilizado para la prevención de estas complicaciones.
Objetivo: determinar el valor de la evidencia actual, sobre la eficacia/seguridad del uso perioperatorio de β-bloqueadores en cirugía no cardiaca, para la prevención de complicaciones cardiacas.
Métodos: se buscó en MEDLINE, Cochrane Library y CINAHL los ensayos clínicos controlados (2000-actualidad) y los meta-análisis (2008- actualidad) recientes, que evaluaron la eficacia de los β-bloqueadores perioperatorios en cirugía no cardiaca, en términos de eventos cardiacos y eventos adversos.
Resultados: los β-bloqueadores perioperatorios disminuyen el riesgo de infarto miocárdico, aunque su eficacia en la reducción de otros eventos cardiacos, la mortalidad cardiaca y la mortalidad general, es contradictoria. Estos resultados dependen del riesgo clínico y quirúrgico de los pacientes incluidos. Con excepción del esmolol, todos los β-bloqueadores estudiados se asocian a un incremento del riesgo de eventos adversos (bradicardia, hipotensión).
Conclusiones: la administración perioperatoria de β-bloqueadores ajustados a la frecuencia cardiaca y presión arterial, es razonable en pacientes con riesgo quirúrgico alto, independientemente de la categoría de riesgo clínico. En el resto de los pacientes, se debe considerar su uso, especialmente si se encuentran taquicardicos de manera prolongada. En los pacientes que previamente consumen β-bloqueadores, se debe continuar el tratamiento en el post-operatorio.

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