Preoperative metoprolol improves cardiovascular stability and reduces oxygen consumption after thoracotomy

Jakobsen, Christian; Bille, S; Ahlburg, P.; L, Rybro; Pedersen, Karen Damgaard; Rasmussen, Bodil Steen

doi:10.1111/j.1399-6576.1997.tb04652.x

Cited by 26 publications

(17 citation statements)

References 20 publications

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“…We excluded 40 trials-36 of which did not evaluate outcomes of interest, one that was a small subgroup analysis from a larger non surgical cohort, 18 and three that were multiple publications from the same dataset [19][20][21] -leaving 33 trials that fulfilled our inclusion criteria. …”

Section: Resultsmentioning

confidence: 99%

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

Bangalore¹,

Wetterslev²,

Pranesh³

et al. 2008

The Lancet

333

173

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Section: Resultsmentioning

confidence: 99%

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

Bangalore¹,

Wetterslev²,

Pranesh³

et al. 2008

The Lancet

333

173

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“…30 – 37 Twenty eight major perioperative cardiovascular events occurred among the 589 patients randomised to β blocker treatment, compared with 55 among the 563 patients randomised to placebo or standard care (relative risk 0.44, 0.20 to 0.97, 0.16 to 1.24). Moderate heterogeneity existed across the trial results (I 2 = 42%).…”

Section: Resultsmentioning

confidence: 99%

How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials

Devereaux

Beattie

Choi

et al. 2005

BMJ

381

248

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Objective To determine the effect of perioperative blocker treatment in patients having non-cardiac surgery. Design Systematic review and meta-analysis. Data sources Seven search strategies, including searching two bibliographic databases and hand searching seven medical journals. Study selection and outcomes We included randomised controlled trials that evaluated blocker treatment in patients having non-cardiac surgery. Perioperative outcomes within 30 days of surgery included total mortality, cardiovascular mortality, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal stroke, congestive heart failure, hypotension needing treatment, bradycardia needing treatment, and bronchospasm. Results Twenty two trials that randomised a total of 2437 patients met the eligibility criteria. Perioperative blockers did not show any statistically significant beneficial effects on any of the individual outcomes and the only nominally statistically significant beneficial relative risk was 0.44 (95% confidence interval 0.20 to 0.97, 99% confidence interval 0.16 to 1.24) for the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal cardiac arrest. Methods adapted from formal interim monitoring boundaries applied to cumulative meta-analysis showed that the evidence failed, by a considerable degree, to meet standards for forgoing additional studies. The individual safety outcomes in patients treated with perioperative blockers showed a relative risk for bradycardia needing treatment of 2.27 (95% CI 1.53 to 3.36, 99% CI 1.36 to 3.80) and a nominally statistically significant relative risk for hypotension needing treatment of 1.27 (95% CI 1.04 to 1.56, 99% CI 0.97 to 1.66). Conclusion The evidence that perioperative blockers reduce major cardiovascular events is encouraging but too unreliable to allow definitive conclusions to be drawn.

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“…We excluded nine studies which reported only major cardiovascular complications within 30 days of surgery [1,2,[21][22][23][24][25][26][27] and a further nine studies which did not present data on perioperative myocardial ischaemia [28][29][30][31][32][33][34][35][36].…”

Section: Resultsmentioning

confidence: 99%

“…Comparison of peri-operative cardiovascular complications in intermediate-risk patients, and the reports relating to higher cardiac risk patients If we examine the ARR of all the beta-blocker studies which report major cardiovascular complications, the ARR is 5.4% for major cardiovascular complications and 7.9% for myocardial ischaemia [1,2,[21][22][23][24][25][26][27]. Interestingly, this is lower than the ARR of 10.9% in perioperative myocardial ischaemia reported in this analysis of intermediate-risk patients.…”

Section: B M Biccardmentioning

confidence: 99%

Acute peri‐operative beta blockade in intermediate‐risk patients

Biccard¹,

Sear²,

Foëx³

2006

Anaesthesia

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SummaryPeri-operative beta-blockade has been shown to reduce the incidence of postoperative cardiovascular complications including cardiac death in high-risk non-cardiac surgical patients. However, the recent analysis by Lindenauer et al. suggests that it is inappropriate to administer beta-blockers blindly to all surgical patients. In an attempt to determine the appropriateness of peri-operative beta-blocker administration across patients with a spectrum of cardiovascular risks, we have examined studies of intermediate-risk patient groups (that is those undergoing intermediate risk surgery or those with a Lee Revised Cardiac Risk Score of £2). We analysed data from randomised prospective studies of the effects of acute peri-operative beta-blockade on the incidence of peri-operative myocardial ischaemia. By examining the demographics and surgical interventions in these patients, we have compared these studies with other studies of peri-operative silent myocardial ischaemia representing patients of similar risk. We thus estimated the expected longterm postoperative cardiovascular complication rate associated with myocardial ischaemia in these patients in terms of number needed to treat for ischaemia prevention and for prevention of major cardiovascular complications. Prevention of peri-operative myocardial ischaemia with acute betablockade in non-cardiac surgical patients with 1-2 RCRI clinical risk factors can be achieved with a number needed to treat of 10.

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Preoperative metoprolol improves cardiovascular stability and reduces oxygen consumption after thoracotomy

Abstract: We found that preoperative beta-blockade during combined general anaesthesia and high thoracic epidural blockade stabilised perioperative HR and CI and decreased total oxygen consumption.

Cited by 26 publications

References 20 publications

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials

Acute peri‐operative beta blockade in intermediate‐risk patients

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