Propranolol and cardiac surgery

The assessment of beta‐adrenoceptor blocking drugs in man.

“…Despite the relationships already shown between plasma concentrations of propranolol and its effects, there have been suggestions that the time-course of propranolol may not always reflect the changes in plasma concentration. On the one hand, the duration of action of,-adrenoceptor blocking drugs has been described as appearing to be longer than would have been appropriate to their plasma elimination half-lives Viljoen, Estafanous & Kellner, 1972;Nigam & Malhotra, 1973); on the other Perrier & Gibaldi (1974) have suggested, on theoretical grounds, that the action of propranolol is related to its concentration in a tissue pool that equilibrates only slowly with plasma. This latter claim has recently been investigated by examining the effects of propranolol on an isoprenaline-induced tachycardia (McDevitt & Shand, 1975).…”

The use of dobutamine in myocardial infarction for reversal of the cardiodepressive effect of metoprolol.

“…There will also be many P-adrenoceptor blocked patients who are in urgent need of surgery. Although many anaesthetists believe that P-adrenoceptor blocking drugs should be withdrawn some days before an operation (Viljoen, Estafanous & Kellner, 1972), this could be dangerous in patients who are well controlled on this therapy for angina pectoris, hypertension, and arrhythmias (Miller, Olson, Amsterdam & Mason, 1975).…”

Esmolol

“…The use of intravenous beta-blockade in patients with CAD, especially if undiagnosed, is associated with its own risks, such as the induction of cardiac failure. There is at least one report documenting intraoperative occurrences of cardiac failure in surgery patients receiving propranolol (38). Since beta-blockade appears to be an effective therapeutic modality for control of perioperative tachycardia or hypertension, we have reasoned that an ultrashort-acting beta-blocker should be safer to use than a long-acting agent.…”