Prophylactic Atenolol Reduces Postoperative Myocardial Ischemia 

Abstract

Perioperative administration of atenolol for 1 week to patients at high risk for coronary artery disease significantly reduces the incidence of postoperative myocardial ischemia. Reductions in perioperative myocardial ischemia are associated with reductions in the risk for death at 2 yr.

Impact of combination medical therapy on mortality in vascular surgery patients

“…Aspirin has been associated with decreased mortality in patients undergoing coronary artery bypass graft surgery, 25 but the effects of aspirin on noncardiac surgery outcomes is less clear. 26 Beta-blockers and statins have been associated with decreased short-term and long-term mortality after vascular surgery in the past, [8][9][10][11][12][13][14] but more recent beta-blocker studies have been negative, introducing controversy for the topic. [15][16][17]27 Beta-blockers are currently recommended as: Class I (should be used), Evidence Level B (limited Association (ACC/AHA) guidelines for perioperative evaluation.…”

“…Perioperative ischemia is associated with a 9-fold increase in the odds of unstable angina, nonfatal myocardial infarction, and cardiac death, while a perioperative myocardial infarction increases the odds of death 20-fold up to 2 years after surgery. [5][6][7] Prior research has centered on the single or combination use of perioperative beta-blockers and statins, which has been associated with decreased short-term and long-term mortality after vascular surgery, [8][9][10][11][12][13][14] with the exceptions of the Metoprolol After Vascular Surgery (MAVS) 15 and the Perioperative Beta-Blockade (POBBLE) studies, 16 which were negative beta-blocker randomized controlled trials exclusively in vascular surgery patients, and the Perioperative Ischemic Evaluation (POISE) study, 17 which was the largest perioperative beta-blocker trial to date in noncardiac surgery, with 41% of the patients undergoing vascular surgery.…”

Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery

“…Eighteen hours after surgery, on the first postoperative day after the patients were allowed to drink water, a postoperative baseline blood sample was collected and 10 mg propranolol was administered per os. For postoperative pharmacokinetics, blood samples were collected at 2,4,6,8,12, and 24 h. EDTA tubes containing blood samples were centrifuged at 1500 g for 10 min and stored at a temperature of -70ºC (-158ºF) until the time for the drug assay.…”

“…ß-adrenoreceptor antagonists improve acute outcomes and long-term prognosis in ischemic heart disease (1) and reduce perioperative events among high risk patients undergoing major non-cardiac and vascular surgery (2,3). Preoperative ß-blocker therapy has been shown to reduce the incidence of intraoperative ischemic events related to increases in heart rate (4,5) and hemodynamic responses to surgical stimulation during revascularization of the myocardium.…”

Best evidence in anesthetic practice

“…There was an error in their beta-blocker metaanalysis which missed one nonfatal myocardial infarction in one randomized controlled trial (RCT) 2 and incorrectly assumed that the myocardial infarctions in another trial, by Wallace and colleagues, 3 were nonfatal. Therefore, there were two nonfatal myocardial infarctions in the beta-blocker group and 16 in the placebo group.…”