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Published on: March 26, 2018
Acute peri-operative beta blockade in intermediate-risk patients
B M Biccard1, J W Sear, P Foëx
1Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford, UK. bruce.biccard@nda.ox.ac.uk
Anaesthesia
|September 19, 2006
Summary
Peri-operative beta-blockade effectively prevents myocardial ischemia in intermediate-risk surgical patients with 1-2 risk factors. However, it shows limited benefit in preventing major cardiovascular complications in non-vascular surgery patients.
Area of Science:
- Cardiology
- Anesthesiology
- Pharmacology
Background:
- Peri-operative beta-blockade is recommended for high-risk surgical patients to reduce cardiovascular complications.
- Recent analyses question the universal appropriateness of beta-blocker administration in all surgical patients.
- Intermediate-risk surgical patients require specific evaluation for peri-operative beta-blocker efficacy.
Purpose of the Study:
- To evaluate the appropriateness of peri-operative beta-blocker administration in intermediate-risk surgical patients.
- To analyze the impact of beta-blockade on peri-operative myocardial ischemia and major cardiovascular complications.
- To determine the number needed to treat (NNT) for preventing ischemia and complications in different surgical risk groups.
Main Methods:
- Analysis of randomized prospective studies on acute peri-operative beta-blockade effects.
- Examination of patient demographics and surgical interventions in intermediate-risk groups.
- Comparison with studies on peri-operative silent myocardial ischemia in similar risk populations.
Main Results:
- Acute beta-blockade prevents peri-operative myocardial ischemia in non-cardiac surgical patients with 1-2 RCRI risk factors (NNT=10) without significant side effects.
- Beta-blockade offers no significant benefit in preventing major cardiovascular complications for intermediate-risk non-vascular surgical patients (NNT=833).
- Vascular surgical patients may benefit, but a large trial (NNT=68, >24,000 patients) is needed to prove efficacy.
Conclusions:
- Beta-blocker use should be risk-stratified, avoiding blind administration in all surgical patients.
- Acute beta-blockade is beneficial for ischemia prevention in specific intermediate-risk non-cardiac surgical patients.
- Further large-scale trials are necessary to confirm the benefits of beta-blockade in intermediate-risk vascular surgery.
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