Possible indications of beta-blockers in the perioperative period other than prevention of cardiac ischemia

Abstract

According to the guidelines of the American College of Cardiology/American Heart Association 2006 for perioperative cardiovascular evaluation for non-cardiac surgery, beta-blocker therapy should be considered for high-risk individuals undergoing vascular surgery or high- and intermediate-risk patients undergoing non-cardiac surgery. This guideline might induce physicians to increasingly use beta-blockers in the hope of preventing perioperative cardiac complications. However, beta-blockers have potential beneficial effects outside the prevention of cardiac events. In addition to reducing anesthetic and analgesic requirements during the perioperative period, beta-blockers have neuroprotective effects in patients with brain trauma and possible effectiveness in the management of intraoperative awareness-induced post-traumatic stress disorder. Moreover, intrathecal administration of beta-blockers may have antinociceptive effects. Physicians need to bear in mind the benefits of beta-blockers for purposes other than preventing cardiac events when applied in the perioperative period, and they should be familiar with the pharmacodynamics and risk-benefit ratio with their use. This review focuses on possible extracardiac indications of beta-blockers.

The effect of perioperative esmolol on early postoperative pain: A systematic review and meta-analysis

“…Besides, a peripheral anti-inflammatory action-related antinociception has also been proposed. [37] Another theory of anesthetic-sparing effects relates to the reduction in cardiac output and hepatic blood flow associated with esmolol influencing the distribution of pharmacokinetics, metabolism, and clearance of propofol or volatile anesthetic agents. [38] Despite the experimental and clinical data relating to a possible antinociceptive effect, the current evidence favoring an inherent analgesic property of esmolol is very weak.…”

“…[38] Despite the experimental and clinical data relating to a possible antinociceptive effect, the current evidence favoring an inherent analgesic property of esmolol is very weak. [373940]…”

“…[26] Nonetheless, BIS was utilized in the studies evaluating the anesthetic-sparing effects of esmolol, and no changes in the anesthetic depth were reported. [37] BIS was not uniformly employed across the included trials.…”

Use of Beta-Blockers in the Perioperative Period: How Strong Are the Evidences?

“…Очевидно, что назначение БАБ в периоперационном периоде должно определяться наличием показаний к их применению независимо от предстоящей хи-рургической операции. Кроме того, в ряде случаев БАБ применяются в периоперационном периоде не толь-ко с целью снижения сердечно-сосудистого риска, а, например, для нейропротекции при травмах головного мозга или вводятся интратекально (эндолюмбально, под оболочки спинного мозга) для усиления антино-цицептивного (противоболевого) эффекта [32]. Од-нако, рекомендуемый временной интервал (опти-мально за месяц до операции) не всегда оправдан с точки зрения своевременности хирургического лече-ния, а титрование дозы до достижения целевых значений ЧСС нередко требует повторных врачебных консультаций.…”

Propranolol Attenuates Surgical Stress–Induced Elevation of the Regulatory T Cell Response in Patients Undergoing Radical Mastectomy

“…It has been reported that the stress response and inflammatory response markedly increase postoperatively and last for 2-3 d (7). In addition, short-term perioperative propranolol or parecoxib administration has been clinically proven to be safer than chronic drug administration and has additional benefits, such as reduction of the dosage of anesthetic and analgesic agents and protection of patients from stroke and cardiac complications (31).…”