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[Perioperative beta-blockers. Part one: fundamentals]
V Piriou1, A Aouifi, J J Lehot
1Service d'anesthésie-Réanimation, Hôpital Cardiovasculaire & Penumologique L. Pradel, Lyon, France.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|August 10, 2000
Summary
Continuing beta-blocker (BB) medication is recommended for perioperative care, except in cases of hypotension or bradycardia. This ensures hemodynamic stability during anesthesia and surgery.
Area of Science:
- Pharmacology
- Cardiovascular Physiology
- Anesthesiology
Context:
- Beta-blockers (BB) are widely used for cardiovascular conditions.
- Their role in perioperative medicine has been debated due to potential adverse effects.
- Understanding BB pharmacology is crucial for safe perioperative prescribing.
Purpose:
- To review the pharmacologic and pathophysiologic information for prescribing beta-blockers in perioperative medicine.
- To elucidate the mechanisms of action and contraindications of various BB agents.
- To provide evidence-based guidance on BB management during the perioperative period.
Summary:
- Cardioselective BB target beta-1 receptors, reducing heart rate and myocardial oxygen demand.
- Non-cardioselective BB affect beta-2 receptors, impacting bronchial and vascular tone.
- Some BB possess vasodilatory properties; contraindications stem from their pharmacological effects.
- BB treatment can lead to increased beta-receptor density, causing sympathetic overactivity upon withdrawal.
- Despite historical concerns, BBs have demonstrated protective hemodynamic effects since the 1970s.
Impact:
- Continued BB administration up to anesthesia is encouraged.
- Exceptions include patients with hypotension or excessive bradycardia.
- This guidance aims to optimize patient outcomes and minimize perioperative cardiovascular events.