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Propranolol and cardiac surgery: a problem for the anesthesiologist?

J A Kaplan, R W Dunbar, J W Bland

    Anesthesia and Analgesia
    |September 1, 1975
    PubMed
    Summary
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    Propranolol can be safely administered within 24 to 48 hours before coronary artery surgery. This beta-blocker therapy did not increase complications in suitable patients undergoing myocardial revascularization.

    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Pharmacology

    Background:

    • Propranolol's potential for myocardial depression raises concerns in cardiac surgery patients.
    • Preoperative propranolol use is common among patients undergoing coronary artery bypass grafting.

    Purpose of the Study:

    • To evaluate the safety and impact of preoperative propranolol administration on outcomes in patients undergoing coronary artery surgery.
    • To determine the optimal timing for discontinuing propranolol before cardiac procedures.

    Main Methods:

    • Retrospective review of 169 consecutive cardiac surgery patients, with 143 on propranolol.
    • Analysis of intraoperative and postoperative complications in relation to propranolol discontinuation timing.
    • Assessment of myocardial contractility using systolic time intervals.

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    Main Results:

    • No increased hypotension or bradycardia before cardiopulmonary bypass in patients taking propranolol up to 24 hours prior.
    • Hypotension after bypass was not more frequent in patients off propranolol for 12-48 hours compared to longer or no exposure.
    • Myocardial contractility normalized 24-48 hours after propranolol cessation; five patients experienced myocardial infarction within 48 hours of stopping the drug.
    • Operative mortality was 4% for patients on propranolol within 48 hours of surgery versus 6% for others.

    Conclusions:

    • Propranolol can be safely administered within 24 to 48 hours of coronary artery surgery.
    • Patients must be satisfactory candidates for myocardial revascularization for safe propranolol use.
    • Seven non-propranolol risk factors were identified in patients needing inotropic support.