Reflections on Beta-Adrenergic Blockade in Anaesthetics

Johnstone, Michael

doi:10.1093/bja/42.3.262

Cited by 13 publications

(8 citation statements)

References 38 publications

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“…Since increasing numbers of patients are receiving beta-adrenergic blocking agents (Pitt and Ross, 1969;Johnstone, 1970;Miller, Amsterdam and Mason, 1975), it has become important to know if an anaesthetic agent possesses a beta-adrenergic stimulating action of any clinical significance and whether the anaesthetic agent is tolerated in the presence of betaadrenergic blockade. Stevens and co-workers (1971) have suggested that some of the haemodynamic effects of isoflurane are consistent with beta-adrenergic stimulation.…”

mentioning

confidence: 99%

Lack of Beta-Adrenergic Activity of Isoflurane in the Dog: A Comparison of Circulatory Effects of Halothane and Isoflurane After Propranolol Administration

Philbin

Lowenstein

1976

British Journal of Anaesthesia

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The studies were undertaken to determine whether isoflurance inhalation is associated with a degree of beta-adrenergic action that is potentially important in clinical situations, and to compare the circulatory tolerance to isoflurane and halothane in dogs following beta blockade. We measured arterial and pulmonary artery pressure, left and right ventricular filling pressure, heart rate and cardiac output, and derived stroke volume and systemic and pulmonary vascular resistances in 13 mongrel dogs. The haemodynamic response to 1 MAC and 2 MAC isoflurane was studied in seven dogs and was similar before and after propranolol 0.1mg/kg i.v. In six dogs, propranolol 0.5mg/kg caused no significant changes in the circulatory response to 1 MAC and 2 MAC isoflurane or 1 MAC halothane. However, in three dogs, administration of 2 MAC halothane after propranolol 0.5mg/kg resulted in such profound circulatory depression as to preclude further study. These data suggest that (a) isoflurane possesses no clinically important beta-adrenergic stimulating activity; (b) there is no adverse drug interaction upon the circulation with the combination of isoflurane and propranolol; (c) in the presence of moderated profound beta-adrenergic blockade, 2 MAC isoflurane may be tolerated better than 2 MAC halothane.

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Lack of Beta-Adrenergic Activity of Isoflurane in the Dog: A Comparison of Circulatory Effects of Halothane and Isoflurane After Propranolol Administration

Philbin

Lowenstein

1976

British Journal of Anaesthesia

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“…Intravenous propranolol has been widely employed in the control of ventricular arrhythmias during anaesthesia. 80,81,82,83,84 Practolol has proved equally effective in this respect. 85,86,39 Hypertensive patients subjected to laryngoscopy prior to endotracheal intubation showed alarming elevations in blood pressure often accompanied by ventricular ectopic beats and unmistakable ECG evidence of severe myocardial ischaemia.…”

Section: Studies In a Wake Or Anaesthetised Humanmentioning

confidence: 99%

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

Roberts

1980

Anaesth Intensive Care

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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.

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“…Hence, one can predict that @-receptor antagonists will either prevent or abolish many arrhythmias occurring during anaesthesia and this has been found to be SO in several species, including man, dog, cat and the horse (Fukushima eta/., 1968;Hellewell and Potts, 1965;Johnstone, 1966aJohnstone, . 1966bJohnstone, , 1970Lees and Tavernor, 1970;Pontinen eta/., 1965;Sharma, 1967). Figure 4 illustrates the tachycardia, which occurred in a horse anaesthetised with halothane, in response to repeated intravenous injections of a standard dose of isoprenaline.…”

Section: Antagonism By @-Adrenergic Blocking Agents Of Ven-tr Icular mentioning

confidence: 99%

“…From the literature it would appear that the commonest causes of arrhythmias from endogenous catecholamines in clinical anaesthesia in man are respiratory acidosis and surgical stimulation during a light plane of anaesthesia. In both instances propranolol will either prevent or abolish the arrhythmias (Johnstone, 1970). It is reasonable, therefore, to ask whether propranolol and other #-receptor antagonists will be of general clinical value in treating arrhythmias that occur in the presence of sensitising agents.…”

Section: Antagonism By @-Adrenergic Blocking Agents Of Ven-tr Icular mentioning

confidence: 99%

The Effects of Some Anaesthetics and Ancillary Agents on Adrenoceptive Receptors

Lees

Tavernor

Hillidge

1971

Proceedings of the Association of Veterinary Anaesthetists

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Reflections on Beta-Adrenergic Blockade in Anaesthetics

Cited by 13 publications

References 38 publications

Lack of Beta-Adrenergic Activity of Isoflurane in the Dog: A Comparison of Circulatory Effects of Halothane and Isoflurane After Propranolol Administration

Lack of Beta-Adrenergic Activity of Isoflurane in the Dog: A Comparison of Circulatory Effects of Halothane and Isoflurane After Propranolol Administration

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

The Effects of Some Anaesthetics and Ancillary Agents on Adrenoceptive Receptors

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