Perioperative beta-blockers for preventing surgery-related mortality and morbidity

Abstract

According to our findings, perioperative application of beta-blockers still plays a pivotal role in cardiac surgery, as they can substantially reduce the high burden of supraventricular and ventricular arrhythmias in the aftermath of surgery. Their influence on mortality, AMI, stroke, congestive heart failure, hypotension and bradycardia in this setting remains unclear.In non-cardiac surgery, evidence shows an association of beta-blockers with increased all-cause mortality. Data from low risk of bias trials further suggests an increase in stroke rate with the use of beta-blockers. As the quality of evidence is still low to moderate, more evidence is needed before a definitive conclusion can be drawn. The substantial reduction in supraventricular arrhythmias and AMI in this setting seems to be offset by the potential increase in mortality and stroke.

Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery

“…Similar results were obtained in an RCT of intravenous perioperative atenolol given to patients undergoing elective non‐cardiac surgery, who had a reduced 2‐year overall mortality after hospital discharge. Blessberger and co‐workers reported a significant decrease in the postoperative incidence of myocardial infarction, supraventricular arrhythmia and myocardial ischaemia in patients undergoing cardiac surgery. Likewise, the POISE trial demonstrated a lower incidence of myocardial infarction in patients treated with metoprolol who were undergoing non‐cardiac surgery.…”

Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery

“…Similar results were obtained in an RCT of intravenous perioperative atenolol given to patients undergoing elective non‐cardiac surgery, who had a reduced 2‐year overall mortality after hospital discharge. Blessberger and co‐workers reported a significant decrease in the postoperative incidence of myocardial infarction, supraventricular arrhythmia and myocardial ischaemia in patients undergoing cardiac surgery. Likewise, the POISE trial demonstrated a lower incidence of myocardial infarction in patients treated with metoprolol who were undergoing non‐cardiac surgery.…”

The interaction between pre-admission β-blocker therapy, the Revised Cardiac Risk Index, and mortality in geriatric hip fracture patients

“…The association between BB therapy and a reduction in mortality after noncardiac surgery, including isolated hip fracture surgery, has been demonstrated previously. 9 , 11 , 13 – 15 The result of the current study suggests that geriatric patients with hip fractures could benefit from BB therapy. These results support current guidelines proposed by the American College of Cardiology in conjunction with the American Heart Association, as well as the European Society of Cardiology together with the European Society of Anesthesiology, which recommend considering the initiation of BB therapy in intermediate and high-risk patients (≥2 clinical risk factors, ASA class ≥3, or RCRI ≥3).…”

β-blocker use before elective percutaneous coronary intervention as a risk factor for periprocedural myocardial injury incidence in male patients below 75 years old: a single-center retrospective study

“…β-blocker therapy works by suppressing the activity of the sympathetic system. It decreases arrhythmias, ischemia, myocardial infarction, the release of cardiac enzymes, and limits the infarct size as revealed in several prospective randomized trials and retrospective studies (27)(28)(29). It also lowers the heart rate, which in turn reduces oxygen consumption during coronary intervention.…”

Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery

“…Similar results were obtained in an RCT of intravenous perioperative atenolol given to patients undergoing elective non‐cardiac surgery, who had a reduced 2‐year overall mortality after hospital discharge. Blessberger and co‐workers reported a significant decrease in the postoperative incidence of myocardial infarction, supraventricular arrhythmia and myocardial ischaemia in patients undergoing cardiac surgery. Likewise, the POISE trial demonstrated a lower incidence of myocardial infarction in patients treated with metoprolol who were undergoing non‐cardiac surgery.…”

The interaction between pre-admission β-blocker therapy, the Revised Cardiac Risk Index, and mortality in geriatric hip fracture patients

“…The association between BB therapy and a reduction in mortality after noncardiac surgery, including isolated hip fracture surgery, has been demonstrated previously. 9 , 11 , 13 – 15 The result of the current study suggests that geriatric patients with hip fractures could benefit from BB therapy. These results support current guidelines proposed by the American College of Cardiology in conjunction with the American Heart Association, as well as the European Society of Cardiology together with the European Society of Anesthesiology, which recommend considering the initiation of BB therapy in intermediate and high-risk patients (≥2 clinical risk factors, ASA class ≥3, or RCRI ≥3).…”

β-blocker use before elective percutaneous coronary intervention as a risk factor for periprocedural myocardial injury incidence in male patients below 75 years old: a single-center retrospective study

“…β-blocker therapy works by suppressing the activity of the sympathetic system. It decreases arrhythmias, ischemia, myocardial infarction, the release of cardiac enzymes, and limits the infarct size as revealed in several prospective randomized trials and retrospective studies (27)(28)(29). It also lowers the heart rate, which in turn reduces oxygen consumption during coronary intervention.…”

Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery

“…Similar results were obtained in an RCT of intravenous perioperative atenolol given to patients undergoing elective non‐cardiac surgery, who had a reduced 2‐year overall mortality after hospital discharge. Blessberger and co‐workers reported a significant decrease in the postoperative incidence of myocardial infarction, supraventricular arrhythmia and myocardial ischaemia in patients undergoing cardiac surgery. Likewise, the POISE trial demonstrated a lower incidence of myocardial infarction in patients treated with metoprolol who were undergoing non‐cardiac surgery.…”

The interaction between pre-admission β-blocker therapy, the Revised Cardiac Risk Index, and mortality in geriatric hip fracture patients

“…The association between BB therapy and a reduction in mortality after noncardiac surgery, including isolated hip fracture surgery, has been demonstrated previously. 9 , 11 , 13 – 15 The result of the current study suggests that geriatric patients with hip fractures could benefit from BB therapy. These results support current guidelines proposed by the American College of Cardiology in conjunction with the American Heart Association, as well as the European Society of Cardiology together with the European Society of Anesthesiology, which recommend considering the initiation of BB therapy in intermediate and high-risk patients (≥2 clinical risk factors, ASA class ≥3, or RCRI ≥3).…”

β-blocker use before elective percutaneous coronary intervention as a risk factor for periprocedural myocardial injury incidence in male patients below 75 years old: a single-center retrospective study

“…β-blocker therapy works by suppressing the activity of the sympathetic system. It decreases arrhythmias, ischemia, myocardial infarction, the release of cardiac enzymes, and limits the infarct size as revealed in several prospective randomized trials and retrospective studies (27)(28)(29). It also lowers the heart rate, which in turn reduces oxygen consumption during coronary intervention.…”