Beta-Adrenergic Blockade and Anaesthesia with Reference to Interactions with Anaesthetic Drugs and Techniques

Abstract

The introduction of the first clinically applicable beta-adrenergic receptor blocking agent (beta-blocker), pronethalol, by Black and Step hens on in 1962 1 heralded a new era in cardiovascular pharmacology. Since that time there has been a rapid increase both in the number of drugs of this type available to clinicians and in the number and variety of indications for their clinical use which now range from the prophylaxis of migraine headaches to the prevention of the deleterious effects of stage fright in musicians. However, their widest application has been in the treatment of hypertension and ischaemic heart disease. 2 ,3 It has therefore become increasingly common for patients receiving long-term therapy with a beta-blocker to present for anaesthesia and surgery. In addition it has been shown that the acute administration of a betablocker may be indicated in some potentially dangerous disturbances of cardiac rhythm caused by increased beta-adrenergic activity which may be encountered in anaesthetic practice. Such over activity may be due to an exaggerated endogenous response or to the administration of sympathomimetic substances by surgeon or anaesthetist.

β‐Receptor Blocker Withdrawal. A Preoperative Problem in General Surgery?

“…However, an abrupt withdrawal of long-term P-receptor blockade may precipitate a rebound phenomenon with serious ischaemic heart events in coronary patients (SLOME 1973, DIAZ et al 1973, ALDERMAN et al 1974, MIILER et al 1975. In contrast to the former recommendation to withdraw the (3-receptor blockade, especially before coronary artery surgery (VIIJOEN et al 1972(VIIJOEN et al , 1975, many authorities therefore nowadays consider it safer to continue the drug therapy (KAPLAN & DUNBAR 1976, SI.OGOFF et al 1978, ROBERTS 1980, CHUNC 1981. In general surgery, however, the large variety of applied surgical and anaesthetic techniques as well as the heterogeneous population of patients, seem to obscure the theoretical basis of such a clear-cut recommendation (HILLIS & COHN 1978).…”