Risk of Myocardial Ischaemia During Anaesthesia in Treated and Untreated Hypertensive Patients

Abstract

Hypertensive patients were monitored for myocardial ischaemia during anaesthesia and surgery with the V5 lead of a standard electrocardiograph. Myocardial ischaemia was detected in 11 of 39 untreated hypertensive patients and in four of seven receiving therapy with a diuretic, but in none of 44 receiving atenolol. Fourteen of the atenolol-treated patients were receiving the drug on a long-term basis and the remaining 30 were treated acutely only on the morning of surgery. When myocardial ischaemia was observed, it was always associated with noxious stimulation and tachycardia, but a conspicuous increase in arterial pressure was not usually present. We conclude that myocardial ischaemia is prevalent during anaesthesia in untreated hypertensive patients, and that pretreatment with atenolol, but not diuretics, provides prophylaxis.

Perioperative β blockers in patients having non-cardiac surgery: a meta-analysis

“…23,26,29,30,33,35,38,39,48 Heart rate achieved was not significant for any of the efficacy outcomes apart from non-fatal myocardial infarction-trials that achieved heart rate of 75 beats per min or less reported a lower reduction in risk than did the other group (tables 2 and 3).…”

“…High-bias risk trials POBBLE 3 Poldermans 32 Jakobsen 46 Jakobsen 34 Lai 35 Magnusson 37 Magnusson 50 Stone 38 Urban 39 Zaugg 3 Poldermans 32 Jakobsen 46 Lai 35 Magnusson 37 Magnusson 50 Miller 40 Stone 38 Urban 39 Zaugg High-bias risk trials Jakobsen 426 Lai 35 Liu 36 Magnusson 50 POBBLE 3 Poldermans 32 Urban 39 Zaugg 33 Jakobsen 46 Stone …”

“…High-bias risk trials Coleman 42 Lai 35 Liu 36 Magnusson 36 POBBLE 3 Poldermans 32 Stone 38 Urban 39 Zaugg 33 Liu 48 33 trials included 12 306 patients having non-cardiac surgery, 6311 (51%) patients randomly assigned to the β-blocker group, and 5995 (49%) to the control group. The β blocker used, dose given, timing of administration, and the duration of administration varied in the trials (table 1).…”

“…[3][4][5][6]22,24,28,[30][31][32][33][34][35][36][37][38][39] However, the test for interaction did not show a significant effect of age category on any of the efficacy outcomes.…”

“…Five trials enrolled high surgical-risk patients (emergency surgery, vascular surgery), 3,5,27,32,40 five enrolled intermediate-risk or high surgical-risk patients, 4,6,28,30,38 22 enrolled intermediate surgical-risk patients (intrathoracic, intraperitoneal, carotid endarterectomy, head and neck, orthopedic, or prostate surgery), [22][23][24][25][26]31,[33][34][35][36][37]39,[41][42][43][44][45][46][47][48][49][50] and one enrolled low surgical-risk patients. 29 A sensitivity analysis on the basis of surgical risk categories showed a 63% decreased risk of all-cause mortality and a 44% decreased risk of non-fatal myocardial infarction in trials with high surgical risk (tables 2 and 3); this finding was driven largely by the trial by Poldermans and colleagues.…”