Modulation of β-adrenergic receptor subtype activities in perioperative medicine: mechanisms and sites of action

Abstract

This review focuses on the mechanisms and sites of action underlying beta-adrenergic antagonism in perioperative medicine. A large body of knowledge has recently emerged from basic and clinical research concerning the mechanisms of the life-saving effects of beta-adrenergic antagonists (beta-AAs) in high-risk cardiac patients. This article re-emphasizes the mechanisms underlying beta-adrenergic antagonism and also illuminates novel rationales behind the use of perioperative beta-AAs from a biological point of view. Particularly, it delineates new concepts of beta-adrenergic signal transduction emerging from transgenic animal models. The role of the different characteristics of various beta-AAs is discussed, and evidence will be presented for the selection of one specific agent over another on the basis of individual drug profiles in defined clinical situations. The salutary effects of beta-AAs on the cardiovascular system will be described at the cellular and molecular levels. Beta-AAs exhibit many effects beyond a reduction in heart rate, which are less known by perioperative physicians but equally desirable in the perioperative care of high-risk cardiac patients. These include effects on core components of an anaesthetic regimen, such as analgesia, hypnosis, and memory function. Despite overwhelming evidence of benefit, beta-AAs are currently under-utilized in the perioperative period because of concerns of potential adverse effects and toxicity. The effects of acute administration of beta-AAs on cardiac function in the compromised patient and strategies to counteract potential adverse effects will be discussed in detail. This may help to overcome barriers to the initiation of perioperative treatment with beta-AAs in a larger number of high-risk cardiac patients undergoing surgery.

Acute peri‐operative beta blockade in intermediate‐risk patients

“…The reduction in the ARR associated with higher-risk patients suggests that in addition to myocardial ischaemia, plaque rupture (for which beta-blockers decrease the concomitant mechanical stress, but not the stability of the plaque [39]) is now contributing to further adverse cardiovascular outcomes [40,41]. In the high-risk surgical patient, adverse cardiac events are approximately evenly distributed between myocardial supply demand imbalances and plaque rupture [40,41].…”

L’aténolol ne modifierait pas les indicateurs de la profondeur de l’anesthésie chez les patients âgés — un réexamen des données

“…1 Titration of anesthetics to HR and BP without ß-blockade may lead to prolonged recovery from anesthesia due to administration of higher doses of anesthetics (MAC-BAR > MACawake). 8 Our post hoc analysis also evaluated the impact of ß-blockade on the performance of routine anesthetic depth indicators using the previously established model of prediction probability P K . 3 The results of these analyses indicate that routinely used hemodynamic variables do not reliably predict BIS, regardless of the presence or absence of ß-blockade.…”

Hipertensão arterial sistêmica e anestesia

“…O uso da nifedipina sublingual com este fim deve ser totalmente desencorajado devido à dificuldade de titulação e às complicações associadas a esta prática 50 . O uso de beta-bloqueadores é particularmente benéfico nos pacientes com HAS e em doença coronariana 51,52 .…”