medigraphic.com
ISSN 1726-6718 (Electronic)
Revista Cubana de Anestesiología y Reanimación

2014, Number 1

<< Back Next >>

Revista Cubana de Anestesiología y Reanimación 2014; 13 (1)

Preoperative Betablockers in non cardiac surgery: recommendations base don evidence

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

Language: Spanish
References: 47
Page: 31-53
PDF size: 596.28 Kb.


ABSTRACT

Introduction: preoperative cardiac events are frequent disorders associated to the increase of mortality. β-blockers have been used for the prevention of these complications.
Objective: determine the value of present evidence about the efficacy/security of the use of β-blockers in the preoperative period in non cardiac surgery for the prevention of cardiac complications.
Methods: it was looked up in MEDLINE, Cochrane Library and CINAHL controlled clinical trials (2000-today) and the recent meta-analysis (2008-today) which evaluated the efficacy of preoperative β-blockers in non cardiac surgery, in terms of cardiac events and side events.
Results: preoperative β-blockers diminish the risk of myocardial infarction, though the reduction of other cardiac events, the cardiac mortality and mortality in general is contradictory. The results depend on the clinical and surgical risks of the patients included. With the exception of esmolol, all β-blockers studied are associated to an increase of side events risks (bradichardia, hypotension).
Conclusion: the preoperative administration of β-blockers adjusted to the hear rate and blood pressure is reasonable in patients with high surgical risk, apart from the category of clinical risk. Its use must be considered in the rest of the patients, especially if they are tachicardic in a prolonged way. In patients who previously take β-blockers, the treatment must continue Hill the postoperative period.


REFERENCES

  1. 1- Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 2008; 372: 139 44.

  2. 2- Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med 1990; 323: 1781-8.

  3. 3- Wallace A, Layug B, Tateo I, Li J, Hollenberg M, Browner W, et al. Prophylactic Atenolol Reduces Postoperative Myocardial Ischemia. Anesthesiology 1998; 88: 7- 17.

  4. 4- Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, Leslie K, Rao-Melacini P, Chrolavicius S, Yang H, Macdonald C, Avezum A, Lanthier L, Hu W, Yusuf S; POISE (PeriOperative ISchemic Evaluation) Investigators. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med 2011; 154: 523- 8.

  5. 5- The VISION Pilot Study Investigators. An international prospective cohort study evaluating major vascular complications among patients undergoing noncardiac surgery:the VISION Pilot Study. Open Med 2011; 5(4): e193-e200.

  6. 6- Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt HG. Perioperative cardiac events in patients undergoing noncardiac surgery: A review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 173: 627-34.

  7. 7- Wallace AW, Au S, Cason BA. Association of the Pattern of Use of Perioperative b-Blockade and Postoperative Mortality. Anesthesiology 2010; 113: 794-805.

  8. 8- Polanczyk CA, Goldman L, Marcantonio ER, et al. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med 1998; 129: 279- 85.

  9. 9- De Decker K, Jorens PG, Van Schil P. Cardiac complications after noncardiac thoracic surgery: an evidence-based current review. Ann Thorac Surg 2003; 75: 1340- 8.

  10. 10- Tisdale JE, Wroblewski HA, Kesler KA. Prophylaxis of atrial fibrillation after noncardiac thoracic surgery. Semin Thorac Cardiovasc Surg 2010; 22: 310- 20.

  11. 11- Jongnarangsin K, Oral H. Postoperative atrial fibrillation. Cardiol Clin 2009; 27: 69-78.

  12. 12- Hyeop Sohn G, Shin DH, Min Byun K, Jin Han H, Jin Cho S, Bin Song Y, et al. The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery. Korean Circ J 2009; 39(3): 100104.

  13. 13- Merritt RE, Shrager JB. Prophylaxis and management of atrial fibrillation after general thoracic surgery. Thorac Surg Clin 2012;22: 13- 23.

  14. 14- Neary WD, McCrirrick A, Foy C, Heather BP, Earnshaw JJ. Lessons learned from a randomised controlled study of perioperative beta blockade in high risk patients undergoing emergency surgery. Surgeon 2006; 4 (3): 139- 43.

  15. 15- Mangano DT, Layug EL, Wallace A, Tateo I, for the Multicenter Study of Perioperative Ischemia Research Group. Effect of Atenolol on Mortality and Cardiovascular Morbidity after Noncardiac Surgery. N Engl J Med. 1996; 335: 1713- 21.

  16. 16- Zaugg M, Bestmann L, Wacker J, Lucchinetti E, Boltres A, Schulz Ch, 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: 33- 44.

  17. 17- Dunkelgrun M, Boersma E, Schouten O, Koopman-van Gemert A, van Poorten F, Bax JJ, Thomson IR, Poldermans D, for The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. Bisoprolol and Fluvastatin for the Reduction of Perioperative Cardiac Mortality and Myocardial Infarction in Intermediate-Risk Patients Undergoing Noncardiovascular Surgery: A Randomized Controlled Trial (DECREASE-IV). Ann Surg 2009; 249: 921- 6.

  18. 18- Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, 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: 1789-94.

  19. 19- Raby KE, Brull SJ, Timimi F, Akhtar S, Rosenbaum S, Naimi C, et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg 1999; 88: 477- 82.

  20. 20- Urban MK, Markowitz SM, Gordon MA, Urquhart BL, Kligfield P. Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg 2000; 90: 1257-61.

  21. 21- Juul AB, Wetterslev J, Gluud Ch, Kofoed-Enevoldsen A, Jensen G, Callesen T, et al. Effect of perioperative b blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ 2006; 332: 1482.

  22. 22- POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. The Lancet 2008; 371: 1839- 47.

  23. 23- Yang H, Raymer K, Butler R, Parlow J, Roberts R. The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 2006; 152: 983-90.

  24. 24- Janet T. Powell, POBBLE Trial Investigators. Perioperative b-blockade (Pobble) for patients undergoing infrarenal vascular surgery: Results of a randomized double-blind controlled trial. J Vasc Surg. 2005; 41: 139- 43.

  25. 25- Lai RC, Xu MX, Huang WQ, Wang XD, Zeng WA, Lin WQ. Bebeficial effects of metoprolol on perioperative cardiac function of elderly esophageal cancer patients. Ai Zheng 2006; 25: 609-13.

  26. 26- Liu Y, Huang CL, He M, Zhang LN, Cai HW, Guo QL. Inûuences of perioperative metoprolol on hemodynamics and myocardial ischaemia in elderly patients undergoing noncardiac surgery. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2006; 31: 249-53.

  27. 27- Beattie WS, Wijeysundera DN, Karkouti K, McCluskey S, Tait G. Does tight heart rate control improve beta-blocker efficacy? An updated analysis of the noncardiac surgical randomized trials. Anesth Analg 2008; 106: 1039- 48.

  28. 28- Biccard BM, Sear JW, Foëx P. Meta-analysis of the effect of heart rate achieved by perioperative beta-adrenergic blockade on cardiovascular outcomes. Br J Anaesth 2008; 100: 23- 8.

  29. 29- Talati R, Reinhart KM, White CM, Phung OJ, Sedrakyan A, Kluger J, et al. Outcomes of perioperative beta-blockade in patients undergoing noncardiac surgery: a meta-analysis. Ann Pharmacother 2009; 43: 1181- 8.

  30. 30- Bangalore S, Wetterslev J, Pranesh S, Sawhney S, Gluud C, Messerli FH. Perioperative beta blockers in patients having non-cardiac surgery: a meta-analysis. Lance. 2008; 372: 1962- 76.

  31. 31- Angeli F, Verdecchia P, Karthikeyan G, Mazzotta G, Gentile G, Reboldi G. ß-Blockers reduce mortality in patients undergoing high-risk non-cardiac surgery. Am J Cardiovasc Drugs 2010; 10: 247-59.

  32. 32- Landoni G, Turi S, Biondi-Zoccai G, Bignami E, Testa V, Belloni I, et al. Esmolol Reduces Perioperative Ischemia in Noncardiac Surgery: A Meta-analysis of Randomized Controlled Studies. J Cardiothorac Vasc Anesth 2010; 24: 219- 29.

  33. 33- Yu SKH, Tait G, Karkouti K, Wijeysundera D, McCluskey S, Beattie WS. The Safety of Perioperative Esmolol: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Anesth Analg 2011; 112: 267- 81.

  34. 34- McGory ML, Maggard MA, Ko CY. A meta-analysis of perioperative beta blockade: what is the actual risk reduction? Surgery. 2005; 138: 171-9.

  35. 35- Devereaux PJ, Beattie WS, Choi PTL, Badner NH, Guyatt GH, Villar JC, et al. How strong is the evidence for the use of perioperative b blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials. BMJ. 2005; 331: 313.

  36. 36- Schouten O, Shaw LJ, Boersma E, Bax JJ, Kertai MD, Feringa HHH, 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. Cor Art Dis. 2006; 17: 173- 9.

  37. 37- Wiesbauer F, Schlager O, Domanovits H, Wildner B, Maurer G, Muellner M, et al. Perioperative b-Blockers for Preventing Surgery-Related Mortality and Morbidity: A Systematic Review and Meta-Analysis. Anesth Analg. 2007; 104: 127- 41.

  38. 38- Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF. 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 2009; 120: e169 e276.

  39. 39- Higgins JPT, Altman DG, Sterne, JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://www.cochrane-handbook.org

  40. 40- Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ 2009; 339: b2700.

  41. 41- Badgett RG, Lawrence VA, Cohn SL. Variations in Pharmacology of [beta]-Blockers May Contribute to Heterogeneous Results in Trials of Perioperative [beta]-Blockade. Anesthesiology 2010; 113: 585- 92.

  42. 42- Poldermans D, Bax JJ, Boersma E, Hert SD, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Lung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OFM, Sicari R, Van den Berghe G, Vermassen F. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur Heart J 2009; 30: 2769812.

  43. 43- van Klei WA, Bryson GL, Yang H, Forster AJ. Effect of beta-blocker prescription on the incidence of postoperative myocardial infarction after hip and knee arthroplasty. Anesthesiology 2010; 111: 717-24.

  44. 44- Noordzij PG, Poldermans D, Schouten O, Schreiner F, Feringa HH, Dunkelgrun M, et al. Beta-blockers and statins are individually associated with reduced mortality in patients undergoing noncardiac, nonvascular surgery. Coron Artery Dis 2007; 18: 67-72.

  45. 45- Feringa HH, Bax JJ, Boersma E, Kertai MD, Meij SH, Galal W, 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 (1 Suppl): I344-9.

  46. 46- Christensen S, Johansen MB, Tønnesen E, Larsson A, Pedersen L, Lemeshow S, et al. Preadmission beta-blocker use and 30-day mortality among patients in intensive care: a cohort study. Crit Care 2011, 15: R87.

  47. 47- Wallace AW, Au S, Cason BA. Perioperative b-Blockade: Atenolol Is Associated with Reduced Mortality When Compared to Metoprolol. Anesthesiology 2011; 114: 824-36.




2020     |     www.medigraphic.com