[Preoperative betablockers use in vascular and thoracic surgery]

[Perioperative heart rate in patients taking beta-blockers: reality and efficiency of the treatment]

OBJECTIVE

To compare perioperative heart rate (HR) control of patients chronically exposed to beta-blockers (BB) with those of patients whom BB treatment was initiated one week preoperatively.

METHODS

HR was noticed at three successive time periods: the anaesthesia visit, just before induction of anaesthesia, and during surgery (maximum and minimum HR). HR, presented as mean+/-SD, was compared among 3 groups of patients: BB chronic treatment, preoperative BB, and a control group not taking BB.

RESULTS

Four hundred (and) six patients were included: 181 chronic BB patients, 20 preoperative BB, and 205 control patients. As compared to the control group, HR of chronic BB patients were lower (P<0.05) than those of the control group at the three time period of the study. In the preoperative BB patient group, one week BB treatment resulted in a mean 30% reduction of HR. Just before induction of anaesthesia, HR of preoperative BB patients was lower than that of chronic BB patients (55+/-11 vs 67+/-13 b/min; P<0.05).

CONCLUSION

Beta-blockers treatment initiated one week before surgery could be more effective on perioperative HR control than chronic BB treatment.

Recent developments in beta-blockers and anaesthesia

PURPOSE OF REVIEW

To evaluate developments on the subject of beta-blockers and anaesthesia published in the past 12 months. The administration of beta-blockers has been established as a pharmacological approach to reduce cardiac events in the perioperative period. A number of studies and reviews have been published underlining the appropriateness of this approach in patients undergoing non-cardiac as well as cardiac surgery. A lack of transfer of the scientific knowledge to clinical practice is evident not only in the field of perioperative medicine, which results in an under-use of beta-blockers. Open questions are still directed towards the optimal dosage, the effectiveness of chronic beta-blockade and the effects of beta-blockade in traumatized and burned patients.

RECENT FINDINGS

Progress in the use of beta-blockers has been realized by the introduction of institutional protocols. In chronic beta-blockade a simple continuation does not provide effective protection. Improved protection might be gained by the combination of beta-blockers and statins in high-risk patients. The role of beta-blockers in pain management is currently a field of interest, although there seem to be many open questions. There are still doubts about the evidence of perioperative beta-blockade: the results of large trials will be published in the next 2 years. The approach is cost-effective: a comparison with other alternative approaches to cardioprotection is pending.

SUMMARY

There has been significant progress in the use of perioperative beta-blockade. Although a considerable amount of knowledge is obvious, the optimal strategy in different clinical settings is still a matter of debate.